Growth Hormone Withdrawal in Mid-Puberty: No Impact on Near Adult Height in Adolescents with Transient Idiopathic GHD

Abstract

Context: In children with idiopathic isolated growth hormone deficiency (IIGHD), GH secretion often normalizes by near adult height (NAH). Whether rhGH treatment can be safely discontinued earlier remains unclear.

Objective: To investigate if withdrawing rhGH treatment from mid-puberty onwards had no negative effect on attained NAH in adolescents who, after retesting, were no longer GH deficient.

Design: Prospective multicenter patient preference study (2017-2024) with follow-up until NAH (SEENEZ GH Study).

Setting: Pediatric endocrinology departments in multiple centers.

Patients or other participants: 127 adolescents (95 male, 75%) with childhood IIGHD (GH peak 1.7-10 µg/L) who tested GH sufficient (GH peak >6.7 µg/L) at mid-puberty. 44 continued rhGH (GHcont), 83 discontinued (GHstop). 99% of patients completed the study.

Interventions: RhGH treatment continuation vs discontinuation from mid-puberty until NAH.

Main outcome measures: Primary: NAH-SDS minus target height (TH)-SDS. Secondary: NAH-SDS, total pubertal growth (TPG), and predicted vs attained height gain.

Results: Mean (SD) NAH-SDS minus TH-SDS was -0.17 (0.60) in the GHcont and -0.18 (0.62) in the GHstop group (P=.96). Mean NAH-SDS was -0.91 (0.76) (GHcont) vs -0.78 (0.76) (GHstop) (P=.35). Mean (SD) TPG (from start of puberty) in males was 27.5 cm (7.0; GHcont) vs 25.9 cm (6.2; GHstop) (P =.25) and in females 20.5 cm (5.7; GHcont) vs 20.9 cm (7.6; GHstop) (P = .90). Predicted vs attained height gain based on the prediction model did not differ between groups.

Conclusions: In adolescents with transient IIGHD, rhGH treatment can be stopped at mid-puberty. These findings support reducing rhGH treatment duration, lowering patient burden and healthcare costs.

Keywords: GH Retesting; Idiopathic Isolated Growth Hormone Deficiency (IIGHD); Mid-Puberty; Near Adult Height (NAH); rhGH Withdrawal.