Background: More than two thirds of teenagers with childhood-onset GH deficiency (CO-GHD) documented normal GH response when retested at final height.
Objective and hypotheses: To identify potential predictors for persistent GHD after reaching final height under rhGH with a particular accent on children with isolated GHD (IGHD).
Method: Prospective study: reevaluation CO-GHD in the transition period; cohort of 27 CO-GHD patient who received rhHG and reached final height; cohort has 20 boys (74%) and 7 girls aged 1420 years, the mean duration of therapy =7.06 years (3 to 12.4 years); average time to cessation of therapy =1.63 years (0.3 to 5.4 years); antropometric parameters were analyzed and GH-IGF1 axis was retested with ITT test. The main outcome measures were sensitivity, specificity, positive and negative predictive values of clinical and hormonal factors for persistent GHD (GHD-P) defined as peak GH <5 ng/ml.
Results: 60% of patients are isolated GHD, 40% are multiple pituitary deficiency (MPD); 32% of IGHD are persistent GHD (IGHD-P) and 68% are reversible IGHD (IGHD-R) (peak GH in ITT > 5 ng/ml). Patients with IGHD-P had a significant initial growth retardation,a significantly lower initial GH response in ITT and significantly better recovery for growth retardation than IGHD-R patients. ≧1 additional pituitary hormone deficiency predicts 100% persistence of GHD status at reevaluation.
Conclusion: Approximately one third of IGHD patients are GHD-P after final height achievement; GH peak value in ITT ≤3 ng/ml at initial diagnosis 100% positive predictive value for status of persistent IGHD; IGF1 value <−1.5 SD at reevaluation requires retesting all pituitary axes given that the combination of additional pituitary deficiency can occur gradually; IGF1 ≤ −2.5 SD at reevaluation - oriented the diagnosis of MPD with 100% specificity in selecting the cases that do not require dynamic tests.
01 - 03 Oct 2015
European Society for Paediatric Endocrinology