Optimal strategy for management of pituitary disease in the growth hormone-deficient teenager

The optimal treatment of chronic conditions spanning pediatric and adult cl inical practice requires the establishment of clear and robust systems for managing the important period of transition of care, This principle is part icularly relevant to the treatment of ongoing pituitary dysfunction after t he achievement of final height and, in addition to the vital component of m aintaining the confidence of the patient, encompasses a number of considera tions that are particularly relevant to long-term health as an adult, These considerations include the achievement of peak bone mass, optimization of gonadal steroid and glucocorticoid replacement, and determination of the ne ed for continuing growth hormone replacement. It is therefore necessary to consider these issues not only from the standpoint of therapeutic principle s but also in the context of practical arrangements for managing the proces s of transition of care. Successful transition can be achieved using a vari ety of models, and there is clearly no single preferable option, The most i mportant ingredient in this process is awareness of the situation by both p ediatric and adult endocrinologists as well as the development of an agreed strategy within each clinical center.