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

• Published in: International journal of pediatric endocrinology 2016-03, Vol.2016 (6), p.6-6, Article 6
• Main Authors: Ahmid, M, Fisher, V, Graveling, A J, McGeoch, S, McNeil, E, Roach, J, Bevan, J S, Bath, L, Donaldson, M, Leese, G, Mason, A, Perry, C G, Zammitt, N N, Ahmed, S F, Shaikh, M G
• Format: Article
• Language: English
• Subjects: Adolescence; Age; Analysis; Clinical medicine; Data collection; Growth hormones; Health aspects; Hormone therapy; Insulin-like growth factors; NMR; Nuclear magnetic resonance; Physical growth; Practice guidelines (Medicine); Somatotropin; Statistical analysis; Young adults
• ISSN: 1687-9848; 1687-9856; 1687-9856
• DOI: 10.1186/s13633-016-0024-8

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