Growth hormone deficiency during young adulthood and the benefits of growth hormone replacement

Abstract

Until quite recently, the management of children with growth hormone deficiency (GHD) had focussed on the use of recombinant human GH (rhGH) therapy to normalise final adult height. However, research over the past two decades that has demonstrated deficits in bone health and cardiac function, as well as impaired quality of life in adults with childhood-onset GHD (CO-GHD), has questioned this practice. Some of these studies suggested that there may be short-term benefits of rhGH in certain group of adolescents with GHD during transition, although the impact of GHD and replacement during the transition period has not been adequately investigated and its long-term benefits remain unclear. GH therapy remains expensive and well-designed long-term studies are needed to determine the cost effectiveness and clinical benefit of ongoing rhGH during transition and further into adulthood. In the absence of compelling data to justify widespread continuation of rhGH into adult life, there are several questions related to its use that remain unanswered. This paper reviews the effects of growth hormone deficiency on bone health, cardiovascular function, metabolic profile and quality of life during transition and young adulthood.

Growth hormone deficiency (GHD) and the importance of growth hormone replacement in transition from late adolescence to adulthood: Guidelines for patients with GHD in transition from pediatric to adult endocrinologist

“…*Studijska grupa za tranziciju pacijenata sa nedostatkom hormona rasta (azbučno): Bajkin Ivana 8,10 , Bojić Vladimir 4 , Vorgučin Ivana 9,10 , Dautović Slavica 9,10 , Đukić Aleksandar 11,13 , Živić Saša 5,7 , Katanić Dragan 9,10 , Lešović Snežana 14 , Marković Slavica 12,13 , Marinković Snežana 14 , Medić Milica 8,10 , Miljić Dragana 1,3 , Pekić Sandra 1,3 , Petakov Milan 1,3 , Sajić Silvija 3,4 , Soldatović Ivan 4,15 , Stanković Sandra 5 , Stojanović Marko 1,3 , Radenković Saša 6,7 , Radojković Danijela 6,7 , Cvetković Vesna 5 , Šaranac Ljiljana 5,7 1 Odeljenje za neuroendokrinologiju, Klinika za endokrinologiju, dijabetes i bolesti metabolizma, Klinički centar Srbije; 2 Оdeljenje za ispitivanje i lečenje žlezda sa unutrašnjim lučenjem, Institut za zdravstvenu zaštitu majke i deteta "Dr Vukan Čupić"; 3 Medicinski fakultet Univerziteta u Beogradu; 4 Tiršova univerzitetska dečja klinika; 5 Odeljenje endokrinologije, Klinika za dečje interne bolesti, Klinički centar Niš; 6 Klinika za endokrinologiju, Klinički centar Niš; 7 Medicinski fakulet Univerziteta u Nišu; 6 bolničkim uslovima na odeljenju "odrasle" endokrinologije. Tada poneti uput za hospitalizaciju, dobijen od nadležnog lekara iz Doma zdravlja.…”

“…*Study Group for GH treatment in transitional period (alphabetically):Bajkin Ivana 8,10 , Bojić Vladimir 4 , Vorgučin Ivana 9,10 , Dautović Slavica 9,10 , Đukić Aleksandar 11,13 , Živić Saša 5,7 , Katanić Dragan 9,10 , Lešović Snežana 14 , Marković Slavica 12, 13 , Marinković Snežana 14 , Medić Milica 8,10 , Miljić Dragana 1,3 , Pekić Sandra 1,3 , Petakov Milan 1,3 , Sajić Silvija 3,4 , Soldatovic Ivan 4,15 , Stanković Sandra 5 , Stojanović Marko 1,3 , Radenković Saša 6,7 , Radojković Danijela 6,7 , Cvetković Vesna 5 , Šaranac Ljiljana 5,7 1 Department for neuroendocrinology, Clinic for endocrinology, diabetes and metabolic diseases, Clinical Centre of Serbia; 2 Endcrinology department, Insittute for healthcare of mother and child "Dr Vukan Čupić"; 3 Medical Faculty, University of Belgrade 4 Tiršova University pediatric Clinic; 5 Department of endocrinology, Clinic for pediatric internal medicine, Clinical Centre Niš 6 Clinic for Endocrinology, Clinical Centre Niš; 7 Medical Faculty, University of Niš; 6 Clinic for endocrinology, diabetes and metabolic diseases, Clinical Centre of Vojvodina, Novi Sad; 9 Institute for health care of children and youth of Vojvodina -Department of Endocrinology, Clinical Center of Vojvodina, Novi Sad; 10 Medical Faculty, University of Novi Sad; 11 Center for Endocrinology, diabetes and metabolic diseases, Clinical Centre Kragujevac; 12 Pediatrics Clinic, Clinical Centre Kragujevac; 13 Faculty of medical sciences University of Kragujevac; 14 Special hospital for thyroid diseases and metabolic diseases "Zlatibor"; 15 Institute for Medical statistics and informactics, Belgrade and be available for the investigation during the morning hours until 12h. In this way patient would be free of commitments in the afternoon until the next morning.…”

“…Replacement is initiated with lower daily doses (0.3 -0.5 mg/d GH) and the dose is further titratred according to serum IGF-1 values and clinical response to treatment, but rarely exceeds 1.6mg/d. GH replacement dose is individaly determined for each patient, aiming for IGF-1 in mid normal age speciffic range 5,7 . Followup of GH replacement during TP should include 6-monthly visits for assessment of body weight and height, waist and hip circumference, blood pressure, fasting glucose, HbA1c and lipid profile, and annual visits to asses quality of life using a speciffic questionaire -AGHDA-QoL, and to asses thyroid status and serum cortisol level.…”

“…Doza se individualno određuje za svakog pacijenta, cilj je da IGF1 bude u sredini normalnog opsega za godine starosti. 5,7 Praćenje terapije hormonom rasta tokom TP podrazumeva šestomesečne kontrole (telesna težina, telesna visina, obim kuka i struka, merenje krvnog pritiska, glikemija, HbA1c, lipidnog profila), godišnje određivanje kvaliteta života pomoću adekvatnog upitnika (AGHDA-QoL) i merenje nivoa tiroidnih hormona i kortizola. Evaluaciju telesnog sastava metodom DXA i gustine kostiju potrebno je sprovesti bazno i svakih 2-5 godina terapije.…”

Glucose Metabolism Evaluated By Glycated Hemoglobin And Insulin Sensitivity Indexes In Children Treated With Recombinant Human Growth Hormone

“…The benefits of human recombinant GH (rhGH) replacement therapy in improving height in children with GH deficiency (GHD) are well recognized (3). RhGH therapy can also improve body composition, lipid profile and bone mineral density (4). With regards to carbohydrate metabolism, observational studies have reported an increased incidence of type 2 diabetes in GH-treated children (5,6) Although the incidence of type 2 diabetes is low (one case for every 3000 person-years of treatment), monitoring glucose levels before and, periodically, during treatment, has been recommended, especially in subjects with preexisting risk factors, such as obesity, positive family history of type 2 diabetes and pretreatment insulin resistance (5,6).…”