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. 2016:2016:6.
doi: 10.1186/s13633-016-0024-8. Epub 2016 Mar 16.

An audit of the management of childhood-onset growth hormone deficiency during young adulthood in Scotland

M Ahmid  1 , V Fisher  1 , A J Graveling  2 , S McGeoch  2 , E McNeil  1 , J Roach  3 , J S Bevan  2 , L Bath  3 , M Donaldson  1 , G Leese  4 , A Mason  1 , C G Perry  5 , N N Zammitt  6 , S F Ahmed  1 , M G Shaikh  1
Affiliations

An audit of the management of childhood-onset growth hormone deficiency during young adulthood in Scotland

M Ahmid et al. Int J Pediatr Endocrinol. 2016.

Abstract

Background: Adolescents with childhood onset growth hormone deficiency (CO-GHD) require re-evaluation of their growth hormone (GH) axis on attainment of final height to determine eligibility for adult GH therapy (rhGH).

Aim: Retrospective multicentre review of management of young adults with CO-GHD in four paediatric centres in Scotland during transition.

Patients: Medical records of 130 eligible CO-GHD adolescents (78 males), who attained final height between 2005 and 2013 were reviewed. Median (range) age at initial diagnosis of CO-GHD was 10.7 years (0.1-16.4) with a stimulated GH peak of 2.3 μg/l (0.1-6.5). Median age at initiation of rhGH was 10.8 years (0.4-17.0).

Results: Of the 130 CO-GHD adolescents, 74/130(57 %) had GH axis re-evaluation by stimulation tests /IGF-1 measurements. Of those, 61/74 (82 %) remained GHD with 51/74 (69 %) restarting adult rhGH. Predictors of persistent GHD included an organic hypothalamic-pituitary disorder and multiple pituitary hormone deficiencies (MPHD). Of the remaining 56/130 (43 %) patients who were not re-tested, 34/56 (61 %) were transferred to adult services on rhGH without biochemical retesting and 32/34 of these had MPHD. The proportion of adults who were offered rhGH without biochemical re-testing in the four centres ranged between 10 and 50 % of their total cohort.

Conclusions: A substantial proportion of adults with CO-GHD remain GHD, particularly those with MPHD and most opt for treatment with rhGH. Despite clinical guidelines, there is significant variation in the management of CO-GHD in young adulthood across Scotland.

Keywords: Adolescence; Childhood onset growth hormone deficiency; Re-evaluation; Retesting; Transition.

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Figures

Fig. 1
Fig. 1
Study Cohort Flow Chart. (n); number of patients, CO-GHD; childhood onset growth hormone deficiency, IGHD; isolated growth hormone deficiency, MPHD; multiple-pituitary hormone deficiencies, GH; growth hormone therapy
See this image and copyright information in PMC

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