Management of Adults with Childhood Growth Hormone Deficiency

Abstract

In August, l996 the FDA approved growth hormone (GH) replacement therapy for growth hormone deficient adults in the US. This approval was based upon studies of growth hormone deficient adults treated with growth hormone in clinical trials in Europe (1). Naturally, the Europeans familiar with these clinical trials and earlier approval developed experience with GH replacement therapy in adults sooner than American adult endocrinologists. Various learning curves had to be developed in the US before adult endocrinologists became comfortable with diagnosing, dosing, and monitoring these patients. Meanwhile, pediatric endocrinologists in the US, long familiar with GH replacement therapy for children, began to struggle with management of GH deficient children who received GH for growth reasons and had achieved their target growth and bone age development with GH therapy. Traditionally, these patients discontinued GH and were not further replaced. Because GH deficient adults were found to have increased mortality rates, fracture rates, and reduced quality of life, and that these parameters seemed to reverse with GH therapy (2–6), questions began to surface concerning whether young adults who were GH deficient as children should be restarted. A number of questions were generated by these circumstances that will be addressed in this review.