Clinical Scorecard: Impact of Mid-Puberty Growth Hormone Discontinuation on Final Height in Adolescents with Transient Idiopathic Growth Hormone Deficiency
At a Glance
Category
Detail
Condition
Idiopathic isolated growth hormone deficiency (IIGHD) with transient GH deficiency in adolescence
Key Mechanisms
Normalization of GH secretion by mid-puberty; rhGH treatment effects mainly before puberty; GH retesting to determine treatment continuation
Target Population
Adolescents diagnosed with childhood IIGHD who test GH sufficient at mid-puberty
Care Setting
Pediatric endocrinology departments in multicenter clinical settings
Key Highlights
In adolescents with transient IIGHD, discontinuing rhGH treatment at mid-puberty does not negatively affect near adult height (NAH).
Approximately 60-70% of children with IIGHD show normal GH peaks at retesting near adult height, indicating transient deficiency.
Continuing rhGH treatment beyond mid-puberty may be unnecessary, potentially reducing treatment burden and healthcare costs.
Guideline-Based Recommendations
Diagnosis
Diagnose IIGHD based on GH peak 1.7-10 µg/L in 2 GH stimulation tests and serum IGF-I levels.
Retest GH secretion at mid-puberty (Tanner stage G3/G4, testicular volume >12 mL in boys) after at least 3 years of rhGH treatment.
Use standardized GH stimulation tests (clonidine, arginine, GHRH + arginine) for diagnosis and retesting.
Management
Offer patients with normalized GH secretion at mid-puberty the option to discontinue rhGH treatment.
Continue rhGH treatment until near adult height only if GH deficiency persists on retesting.
Monitor growth velocity; growth rate <2 cm/year or <15 mm over 6 months suggests near adult height.
Monitoring & Follow-up
Monitor height standard deviation scores (SDS) relative to target height (TH) during and after treatment.
Assess total pubertal growth and predicted vs attained height gain to evaluate treatment impact.
Retest GH secretion at near adult height to determine need for adult rhGH therapy.
Risks
Untreated adult GHD is associated with metabolic complications including diabetes, osteoporosis, and dyslipidemia.
Misclassification due to variability in GH stimulation tests may lead to unnecessary treatment.
Prolonged rhGH treatment beyond mid-puberty in transient IIGHD may increase patient burden and healthcare costs without height benefit.
Patient & Prescribing Data
127 adolescents with childhood IIGHD who tested GH sufficient at mid-puberty
Discontinuation of rhGH at mid-puberty in GH sufficient adolescents resulted in similar near adult height outcomes compared to continuation, supporting treatment cessation at this stage.
Clinical Best Practices
Retest GH secretion at mid-puberty to identify transient IIGHD and guide treatment duration.
Engage patients and families in shared decision-making regarding continuation vs discontinuation of rhGH at mid-puberty.
Use patient preference study designs when randomized controlled trials are not feasible due to patient willingness.
Apply national protocols for GH stimulation testing and classification to standardize diagnosis and management.
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
