Treatment of Persistent Growth Hormone Deficiency in the Transition Period
The transition period — from late puberty through the establishment of adult muscle and bone composition, including attainment of adult height — is a clinically significant window for patients with persistent growth hormone deficiency. Identifying and treating this population requires specific diagnostic criteria and a carefully tailored approach.
Clinical Scenario
Persistent GHD in the transition period applies to patients with three or more pituitary hormone deficiencies (regardless of etiology), those with a documented causal genetic mutation, or those with a specific pituitary or hypothalamic structural defect. This scenario encompasses the span from late puberty until adult height and full adult body composition are established.
Clinical Goals
- Increased bone mineral density
- Normalized serum IGF-I levels for age and gender
- Improved lipid profiles from baseline
Treatment Approach
Recombinant human growth hormone therapy may be offered to patients with confirmed persistent GHD in the transition period. The specific dosing strategy and titration approach are individualized — the complete evidence-based regimen is available in the full protocol.
References
DOI: 10.1159/000452150
- We recommend that patients with multiple (≥3) pituitary hormone deficiencies regardless of etiology, or GHD with a documented causal genetic mutation or specific pituitary/hypothalamic structural defect except ectopic posterior pituitary, be diagnosed with persistent GHD.
- The transition period is the time from late puberty to establishment of adult muscle and bone composition, and encompasses attainment of AH.
- We suggest that GH treatment be offered to individuals with persistent GHD in the transition period.
- Three RCTs in young adults with persistent GHD indicated that 2 years of GH treatment increased bone mineral density, normalized IGF-I levels, and improved lipid profiles from baseline.
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