ESPE Abstracts

Introduction: The transition period between childhood and adulthood in patients with growth hormone deficiency is a vulnerable period during the follow-up. Different consensuses have established follow-up and reassessment protocols for this period in order to clarify whether GHD persists. The benefits of maintaining treatment during this period are widely documented on the metabolic, vascular, bone and in terms of quality of life and well-being.

Aims of the study: To evaluate the clinical and biological status of patients with growth hormone deficiency followed since childhood during the transition period (14-16 years).

Patients and method: Out of 255 patients followed in pediatric endocrinology from September 2007 to March 2023, 51 patients reached age of transition (14-15 years). Clinical data were collected. In patients GHD with normal MRI, treatment was interrupted for one month. Iinsulin or glucagon test was performed to reassess growth hormone function. The GH threshold defining GHD is 3µg/L for the insulin test. For glucagon test, the cut off is 3µg/L for patients with BMI <30Kg/m2 and 1µg/L for patients whose BMI is > 30Kg/m2. IGF1 values after discontinuation of treatment are interpreted according to age and sex.

Results: The average age of 51 adolescents reaching transition period is 15.83 years with male predominance. 80.3% of patients had an isolated deficiency and 19.6% had other anterior pituitary deficiencies. Hypothalamic-pituitary MRI found pituitary abnormalities in 39%of patients. MRI was normal in the other cases. The average stature gain in terms of standard deviation is 1.88 SD, it is greater in the GHD group with MRI abnormalities (P<0.05). The final height after average treatment of 8 years increased from -2.9 SD before treatment to -1.02 SD at the end of treatment. The average bone age in the transition period is 14.89 years. Biological reassessment in 38 patients confirmed the persistence of GHD in 12.7% of patients with normal MIR, leading to the renewal of treatment and the transfer of follow-up by the adult pituitary unit. 13.6% of patients presented with other anterior pituitary deficits during follow-up.

Conclusion: Evaluation in transition phase revealed a satisfactory stature gain. Reassessment of somatotropic function in patients with normal MRI demonstrated persistence of GH deficiency in less than a quarter of the patients which led to the renewal of treatment. Patients aged over 18 still treated were transferred to the adult pituitary unit.