Transition of childhood-onset growth hormone-deficient patients to adult healthcare.

In patients with childhood-onset growth hormone (GH) deficiency who have reached adult height, the transition from pediatric to adult healthcare is an appropriate time for reassessment of GH status. For patients in whom persistent GH deficiency (GHD) is established by appropriate testing, reinstitution of GH therapy or its continuation can improve quality of life, optimize body composition and bone mineral density, as well as reduce cardiovascular risks associated with GHD. Ongoing GH therapy should be individualized with attention paid to changes in serum insulin-like growth factor (IGF)-I concentrations, body composition, and occurrence of adverse effects such as edema and arthralgia. GH deficient patients who discontinue childhood GH replacement therapy and are not restarted as adults should undergo long-term surveillance to detect possible adverse consequences (e.g. reduced bone mineral density) typically associated with interruption of GH treatment.