Endocrine Abstracts

Growth hormone replacement is not essential but it is an important treatment for adult with GH deficiency and for adults with childhood onset GH deficiency, the aim of management changes as they grow which involves testing and retesting, clarification of the replacement aim and adjustments of the dosage accordingly. This is a case of a 29 year old man who presented with short stature during childhood at the age 7 yr old and subsequently found to have growth hormone (GH) deficiency. Other pituitary hormones ares normal and pituitary MRI done twice showed a small anterior pituitary gland with other intracranial appearance reported as normal. He had GH (Zomacton 1.4 mg daily) treatment between age 7-17 and stopped. He was subsequently transitioned to adult endocrinology service a year after and the most prominent symptoms on assessment was excessive tiredness. Repeat pituitary and general screening were essentially normal. He had the end of growth assessment with ITT with peak GH level of 1.0 despite adequate hypoglycaemia achieved. He was therefore restarted on GH (Easypod at the adult dose of 0.4 mg daily) at the age of 18 years. He was reassessed after three months and there was improvement in the energy level. At the age of 25 years, GH was discontinued and he had a repeat assessment with ITT which showed the peak GH of 0.8 and had the AGHDA questionnaire checked off GH with score 24/25 which improved when he was started on Omnitrope to 10/25 the following year. This case illustrate the three phases of GH replacement in childhood onset growth hormone deficiency. This is because the longitudinal growth is the aim during the childhood, between age 18 and 25, growth hormone is important for body composition and well being. However, after the age of 25 years, the only indication for replacement is the quality of life which is asssessed by the AGHDA questionnaire and not strictly only the biochemical finding of GH deficiency. The case also highlight the dose and device indications as the dosage changes during this period and in this case, there was also a change of the GH devices from the group 2 products to the cheaper group one product- and this call for review of the indications for those device at each stage of reassessment in order to reduce the service cost.