Management of Adults with Childhood-Onset Growth Hormone Deficiency

In patients with childhood-onset growth hormone (GH) deficiency (GHD), linear growth is the most evident and objective parameter to monitor GH therapy during infancy and puberty. Once adult height is achieved, and the patient transits from puberty to adulthood, confirmation of the diagnosis of GHD may be needed to assess the need for long-term replacement therapy. Depending on the etiology of GHD, patients have different chances of having persistent GH deficits. Most of the children with an isolated, idiopathic GHD are likely to restore a physiological GH secretion during transition, whereas those with anatomic hypothalamic-pituitary damage and/or multiple pituitary hormone deficiencies have a higher likelihood of remaining GH deficiency. Retesting the patient during the transition from puberty to adulthood can be challenging; in most cases, there are no basal laboratory tests able to confirm GHD, and dynamic evaluation is influenced by several variables that might make the results difficult to interpret. GH replacement therapy (GHRT) has proven benefits on bone maturation, metabolism control, and quality of life. However, it has contraindications and potential side effects as well, and the decision to restart the treatment should be discussed extensively with the patients and their families and tailored to every single case.