Issues in the transition from childhood to adult growth hormone therapy

The consequences of severe growth hormone deficiency (GHD) in adults and th e beneficial effects of GH replacement therapy are clear. However, the majo rity of children who have a diagnosis of GHD and who are treated with GH do not have permanent GHD and will not require treatment during adulthood. Se veral issues must be considered in selecting candidates for adult GH treatm ent and transitioning their care from pediatrics to adult medicine. Counsel ing about possible lifelong treatment should focus on children with panhypo pituitarism and those with severe isolated GHD that is associated with cent ral nervous system abnormalities. When to terminate growth-promoting GH the rapy should be guided by balancing the high cost of late-adolescent treatme nt with the attainment of reasonable statural goals. Retesting for GH secre tion is appropriate for all candidates for adult GH therapy; the GH axis ca n be tested within weeks after the cessation of treatment, but confirming a n emerging adult GHD state with body composition, blood lipid, and quality- of-life assessments may require 1 year or more of observation. Selecting pa tients for lifelong adult GH replacement therapy will present diagnostic, t herapeutic, and ethical problems similar to those in treating childhood GHD . The experience and expertise of pediatric endocrinologists in diagnosing and treating GHD should be offered and used in identifying and transitionin g appropriate patients to adult GH therapy.