Prospective Follow-up of Children with Idiopathic Growth Hormone Deficiency After Termination of Growth Hormone Treatment: Is There Really Need for Treatment at Transition to Adulthood?

OBJECTIVE: Continuation of growth hormone (GH) treatment in adolescents with severe childhood onset idiopathic GH deficiency (IGHD) during the transition period, irrespective of achievement of final height, is still debatable. We aimed to prospectively investigate the metabolic profile, bone mineral density (BMD) and body composition of patients with IGHD in whom GH treatments were terminated after they had reached their final height, six months after the cessation of therapy.

METHODS: Twelve patients, six of whom had peak GH levels <5 ng/mL [permanent GH deficiency (GHD), group 1], and six who had peak GH levels >5 ng/mL (transient GHD, group 2) after insulin stimulation test were evaluated for anthropometric and laboratory parameters including fasting blood glucose (FBG), fasting insulin, lipid profile, BMD, body composition measurements and 24-hour ambulatory blood pressure monitoring before (baseline) and at six months after discontinuation of GH.

RESULTS: No differences were found in clinical, laboratory, BMD and body composition measures between groups 1 and 2 at baseline. All IGHD patients had significant increments of body weight (BW), body mass index (BMI), BMD, total body fat (TBF), TBF%, truncal fat (TF) and TF% after GH cessation. Six months later BW, BMI, BMD and TF% was increased significantly while FBG and lipids showed no change in group 1. In group 2, TBF% and TF% were increased, FBG, total cholesterol and high-density lipoprotein decreased after six months. Changes in these parameters in group 2 were not statistically different from group1.

CONCLUSION: TF% increase in both groups after cessation of therapy. We did not observe a clinical condition requiring GH treatment in any of the study subjects during the follow-up period.