Managing the transition of adolescents with GH deficiency

From a pediatrician's perspective, the dominant feature of growth GH deficiency has always been slow growth with severe dwarfism unless GH is replaced. In the early years of GH therapy the hormone was so scarce that only severely affected children were offered treatment using dosing regimens considered modest by today's standards. The major goal of treatment was to stimulate linear growth, hopefully reaching a final height within the normal range, but generally accepting stature below that expected based on the parents' heights. The only indication for GH apart from this was to prevent hypoglycemia in GH-deficient infants. The advent of recombinant GH irrevocably altered the approach to individuals with GH deficiency. Treatment could be given at an early age, continuously and optimized for growth. Though the metabolic effects of GH have been known for years, it has only been over the last decade that the phenotype of adult GH deficiency has been defined and the beneficial effects of GH replacement proven for those who have completed skeletal growth. Now that we are in a new era of GH therapy for adults, physicians caring for children with GH deficiency must consider which patients may benefit from life-long replacement with GH. The use of GH for adults has been the subject of published consensus statements and reviews. The objective here is to focus on the issues that relate to the management of patients who are at the transitional stage of GH therapy, i.e. where linear growth in nearly complete or satisfactory and the issue of continuing GH for non-statural indications is at hand. What follows is brief discussion of what is known and what is not known concerning the use of GH during transition from adolescence to adulthood, accompanied by the Author's suggestions for management.