Impact of Mid-Puberty GH Discontinuation on Final Height in Transient IIGHD Adolescents
Overview
In adolescents with transient idiopathic isolated growth hormone deficiency (IIGHD) who retest as GH sufficient at mid-puberty, discontinuing recombinant human growth hormone (rhGH) treatment does not negatively affect near adult height (NAH). This prospective multicenter study found no significant differences in final height outcomes between those who continued versus stopped rhGH at mid-puberty.
Background
Idiopathic isolated growth hormone deficiency (IIGHD) is diagnosed in about half of children treated with rhGH for growth hormone deficiency. Typically, rhGH treatment continues until near adult height (NAH) is reached. However, many patients with IIGHD normalize GH secretion by NAH, raising questions about the necessity of prolonged treatment. Retesting at mid-puberty can identify those who are no longer GH deficient, potentially allowing earlier treatment discontinuation.
Data Highlights
Outcome Measure
GH Continue (n=44)
GH Stop (n=83)
P Value
NAH-SDS minus Target Height (TH)-SDS
-0.17 (0.60)
-0.18 (0.62)
0.96
NAH-SDS
-0.91 (0.76)
-0.78 (0.76)
0.35
Total Pubertal Growth (males, cm)
27.5 (7.0)
25.9 (6.2)
0.25
Total Pubertal Growth (females, cm)
20.5 (5.7)
20.9 (7.6)
0.90
Key Findings
Mean NAH-SDS minus target height SDS was nearly identical between groups continuing and stopping rhGH (-0.17 vs -0.18, P=0.96).
Mean NAH-SDS showed no significant difference between GH continuation and discontinuation groups (-0.91 vs -0.78, P=0.35).
Total pubertal growth in males and females did not differ significantly between groups.
Predicted versus attained height gain was similar regardless of rhGH continuation or discontinuation at mid-puberty.
99% of enrolled patients completed the study, supporting robustness of findings.
Findings support that rhGH treatment can be safely stopped at mid-puberty in adolescents with transient IIGHD who retest GH sufficient.
Clinical Implications
For adolescents with transient IIGHD who demonstrate normal GH secretion at mid-puberty retesting, clinicians can consider discontinuing rhGH treatment without compromising final height outcomes. This approach may reduce treatment burden, improve patient quality of life, and decrease healthcare costs. Retesting at mid-puberty is therefore an important step in individualized management of IIGHD.
Conclusion
Discontinuation of rhGH treatment at mid-puberty in adolescents with transient IIGHD who retest as GH sufficient does not adversely affect near adult height. These results support revising treatment protocols to allow earlier cessation of rhGH in this population.
References
SEENEZ GH Study Group 2017-2024 -- Impact of Mid-Puberty Growth Hormone Discontinuation on Final Height in Adolescents with Transient Idiopathic Growth Hormone Deficiency
by Joeri Vliegenthart, Jan M Wit, Boudewijn Bakker, Annemieke M Boot, Christiaan de Bruin, Martijn J J Finken, Josine C van der Heyden, Anita C S Hokken-Koelega, Hetty J van der Kamp, Edgar G van Mil, Theo C J Sas, Dina A Schott, Petra van Setten, Saartje Straetemans, Vera van Tellingen, Robbert N H Touwslager, A S Paul van Trotsenburg, Paul G Voorhoeve, Edmond H H M Rings, Erica L T van den Akker, Danielle C M van der Kaay
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