Consensus statement on the management of the GH-treated adolescent in the transition to adult care

Clayton, Peter E.; Cuneo, Ross C.; Juul, Anders; Monson, John P.; Shalet, Stephen M; Tauber, Maïté

doi:10.1530/eje.1.01829

Cited by 240 publications

(266 citation statements)

References 21 publications

(10 reference statements)

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“…In children treated for GHD, therapy should be continued beyond the achievement of target height, usually between 17 and 19 years, until full somatic development is reached in the mid to late 20s; this period of time reflects the transition between adolescence and full adult development. Guidelines have been issued by the European Society of Paediatric Endocrinology regarding the investigation and management of GHD during this period (11). There is some evidence that even in the absence of severe deficiency, partial GHD in young people (peak GH response 3-11.8 mg/l on provocation testing) may have a negative effect on body habitus (12).…”

Section: Diagnosismentioning

confidence: 99%

“…Furthermore, hypopituitarism is associated with increased cardiovascular mortality (3,50) and GHD may be aetiologically implicated. The cardiovascular impact of long-standing GHD is such that reduction in cardiovascular risk has been cited as one of the aims of GH replacement in adolescence (11). GH replacement is usually associated with a neutral effect on blood pressure (BP) (38); the antinatriuretic and possible chronotropic actions of GH are offset by vasodilation arising from increased generation of endothelial nitrous oxide.…”

Section: Other Cardiovascular Risk Factorsmentioning

confidence: 99%

“…It is now accepted that GH replacement should not be discontinued in the GHD adolescent at the completion of linear growth but should be maintained until full somatic development has been achieved (11). These recommendations are based on studies by Drake et al that showed that cessation of GH replacement in adolescents at the completion of linear growth is associated with negligible further gain in median total body bone mineral content (BMC) over 1 year (C2.4%, PZ0.5), whereas adolescents who continue to receive GH replacement continue to increase their median BMC (C6.0%, P!0.001) (56).…”

Section: Bonementioning

confidence: 99%

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Adult GH deficiency throughout lifetime

Thomas

Monson

2009

European Journal of Endocrinology

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It is now accepted that adults with severe GH deficiency (GHD) demonstrate impaired physical and psychological well-being and may benefit from replacement with recombinant human GH. Postmarketing surveillance surveys, such as the Pfizer International Metabolic Database (KIMS), were initially set-up to provide safety data on long-term treatment but have the added benefit of providing ongoing observational data on the effect of GH replacement on body composition, lipid and glucose status, hypertension, bone density and quality of life. These data demonstrate that although GHD has clinical impact at all ages, the individual consequences of this condition may take on greater significance at different stages in life. At all ages, accurate, safe diagnosis and appropriate GH dosing are necessary to provide the individual with the best possible outcome.

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Section: Diagnosismentioning

confidence: 99%

Section: Other Cardiovascular Risk Factorsmentioning

confidence: 99%

Section: Bonementioning

confidence: 99%

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Adult GH deficiency throughout lifetime

Thomas

Monson

2009

European Journal of Endocrinology

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“…O pico da massa óssea ocorre dentro do período de transição e é dependente da ação do GH (7,(14)(15)(16). A suspensão da reposição de GH em adolescentes com DGH leva à diminuição dos marcadores de formação e reabsorção óssea, indicando a redução na atividade de remodelação óssea (13,14).…”

Section: Massa óSseaunclassified

“…A reavaliação do paciente com diagnóstico de DGH deve ser realizada após suspensão da aplicação do GH por período de pelo menos 30 dias (2,7,30). O teste considerado padrão-ouro para reavaliar a secreção de GH nestes pacientes é o teste de tolerância à insulina (ITT), porém, ele é contra-indicado em pacientes convulsivos ou portadores de cardiopatias (31).…”

Section: Risco Cardiovascularunclassified

Condução do tratamento com hormônio de crescimento (GH) nos pacientes com diagnóstico de deficiência GH (DGH) durante o período de transição da criança para o adulto

Portes

Barbosa

2008

Arq Bras Endocrinol Metab

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Além de estimular o crescimento estatural, o hormônio de crescimento (GH) promove outros efeitos benéficos nos pacientes com deficiência de GH (DGH). A suspensão do GH em pacientes com DGH, durante o período de transição da criança para a vida adulta, induz a alterações metabólicas desfavoráveis na composição corporal, na integridade óssea, na capacidade para desempenhar atividade física, e também aumenta fatores de risco cardiovasculares. Estes parâmetros melhoram quando a reposição do GH é reiniciada em adultos com DGH. Com base nestas evidências, a reposição do GH não deveria ser suspensa quando o paciente atingisse sua altura final e, sim, mantida durante a vida adulta. Entretanto, considerando que muitos pacientes com diagnóstico de DGH, quando criança, não tem este diagnóstico confirmado no início da vida adulta, é necessário reavaliar a secreção de GH quando o paciente atingir a altura final. A história clínica do paciente, a resposta ao tratamento com GH, a ressonância magnética da região hipotalâmica-hipofisária e a concentração de IGF-1 podem ajudar nesta reavaliação. A realização de testes de estímulo para liberação do GH é necessária, a menos que o paciente apresente lesão estrutural ou genética que justifiquem a deficiência deste hormônio.

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Hormone Replacement Therapy

Janssen

Lely

Rogol

et al. 2013

Pituitary Disorders

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vaccinationists, it is important to understand that they have deeply held beliefs, often of a spiritual or philosophical nature, 11 and these beliefs have remained remarkably constant over the better part of two centuries. The movement encompasses a wide range of individuals, from a few who express conspiracy theories, to educated, well informed consumers of health care, who often have a complex rationale for their beliefs, related to a "mixture of world views held about the environment, healing, holism. .. and a critical reading of the scientific and alternative literature." 12 Vaccination is unique among de facto mandatory requirements in the modern era, requiring individuals to accept the injection of a medicine or medicinal agent into their bodies, and it has provoked a spirited opposition. This opposition began with the first vaccinations, has not ceased, and probably never will. From this realisation arises a difficult issue: how should the mainstream medical authorities approach the anti-vaccination movement? A passive reaction could be construed as endangering the health of society, whereas a heavy handed approach can threaten the values of individual liberty and freedom of expression that we cherish. This creative tension will not leave us and cannot be cured by force alone.

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Consensus statement on the management of the GH-treated adolescent in the transition to adult care

Cited by 240 publications

References 21 publications

Adult GH deficiency throughout lifetime

Adult GH deficiency throughout lifetime

Condução do tratamento com hormônio de crescimento (GH) nos pacientes com diagnóstico de deficiência GH (DGH) durante o período de transição da criança para o adulto

Hormone Replacement Therapy

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