Approach to the patient: Approach to the growth hormone-deficient child during transition to adulthood

The observation that some adults with childhood-onset GH deficiency have low bone mineral density, low lean body mass, diminished quality of life, abnormal lipids, and impaired cardiac function, all of which may improve after treatment with GH, has prompted pediatric endocrinologists to reevaluate the practice of discontinuing GH in all patients after attainment of final adult height. The treatment of adolescents to prevent the metabolic complications of GH deficiency is an emerging practice. Studies addressing the evaluation and care of adolescents during this period and the benefits of GH in this setting are conflicting. Our approach in determining which adolescents to retest, when and how to test for persistent GH deficiency, and which subjects to treat is discussed in the context of available clinical data.