Growth Hormone (GH) Therapy During the Transition Period: Should We Think about Early Retesting in Patients with Idiopathic and Isolated GH Deficiency?

Laura Penta, Marta Cofini, Laura Lucchetti, Letizia Zenzeri, Alberto Leonardi, Lucia Lanciotti, Daniela Galeazzi, Alberto Verrotti and Susanna Esposito
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Laura Penta: Paediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06132 Perugia, Italy
Marta Cofini: Paediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06132 Perugia, Italy
Laura Lucchetti: Paediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06132 Perugia, Italy
Letizia Zenzeri: Paediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06132 Perugia, Italy
Alberto Leonardi: Paediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06132 Perugia, Italy
Lucia Lanciotti: Paediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06132 Perugia, Italy
Daniela Galeazzi: Paediatric Unit, Narni Hospital, 05035 Narni (PG), Italy
Alberto Verrotti: Department of Paediatrics, University of L’Aquila, 67100 L’Aquila, Italy
Susanna Esposito: Paediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06132 Perugia, Italy

IJERPH, 2019, vol. 16, issue 3, 1-9

Abstract: To investigate growth hormone (GH) secretion at the transition age, retesting of all subjects who have undergone GH replacement therapy is recommended when linear growth and pubertal development are complete to distinguish between transitional and persistent GH deficiency (GHD). Early retesting of children with idiopathic and isolated GHD (i.e., before the achievement of final height and/or the adult pubertal stage) can avoid possible over-treatment. Here, we report data from our population with idiopathic and isolated GHD to encourage changes in the management and timing of retesting. We recruited 31 patients (19 males) with idiopathic GHD who received recombinant GH (rGH) for at least 2 years. All of the patients were retested at the transition age at least 3 months after rGH discontinuation. Permanent GHD was defined as a GH peak of <19 ng/mL after administration of growth hormone–releasing hormone (GHRH) + arginine as a provocative test. Permanent GHD was confirmed in only five of 31 patients (16.13%). None of these patients presented low serum insulin-like growth factor (IGF)-1 levels (<−2 standard deviation score (SDS)). Only one male patient with an IGF-1 serum level lower than −2 SDS showed a normal GH stimulation response, with a GH peak of 44.99 ng/mL. Few patients with idiopathic and isolated GHD demonstrated persistence of the deficit when retested at the transition age, suggesting that the timing of retesting should be anticipated to avoid overtreatment.

Keywords: growth hormone deficiency; transition age; growth hormone retesting (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2019
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