Endocrine Abstracts

Background: The main aim of growth hormone(GH) treatment during childhood is to attain optimal final height. As a young adult GH treatment is important to achieve optimal body composition (including peak bone mass), psychosocial development and to reduce metabolic and cardiovascular risks. At completion of linear growth (height velocity [HV] <2 cm/year), it is recommended that GH treatment should be discontinued, and GH status reassessed to determine the eligibility for adult GH treatment.

Objectives: To review whether young people (YP) with CO-GHD, who have completed linear growth, have been re-tested to determine eligibility for adult GH treatment, as per NICE clinical guidelines.

Method: Retrospective medical record analysis of 60 YP with CO-GHD who had completed linear growth, followed-up in an adolescent endocrinology centre between 2018 to 2023.

Results: Of 60 YP who had completed linear growth (ages 14.3 to 19.6 years), 28 had isolated growth hormone deficiency (IGHD) and 32 had multiple pituitary hormone deficiencies (MPHD). 15% (n=9) YP received adult GH therapy without retesting (of which 89% had MPHD); 68% (n=41) were retested with a GH stimulation test (IGHD n=18, MPHD n=23); 15% (n=9) are still awaiting a stimulation test; and one patient refused retesting and opted to stay off GH. An Insulin tolerance test (ITT) was performed in 39 YP who were retested; two YP had a glucagon test. The interval between completion of linear growth to retesting ranged from 3 to 23 months. All patients were off GH for at least 2 months before retesting. 92% (n=38) YP who had stimulation tests had a peak GH <3 mg/L (IGHD n=15, MPHD n=23). 2 YP had peak GH level >3 mg/L, and GH therapy stopped. One YP had peak GH >3 mg/L but received adult GH therapy due to severe symptoms. Starting adult GH dose was 0.2 mg to 1 mg.

Conclusion: The majority of YPs with CO-GHD were eligible for adult GH treatment after retesting, including all patients with MPHD. Practice was variable regarding time between reaching final height and retesting, and also the starting adult GH dose.