Objective: To analyze metabolic parameters, body composition (BC) and bone mineral density (BMD) in childhood onset GH deficiency (COGHD) patients during transition period (TP).
Design: Single center, retrospective study was performed on 170 consecutive COGHD patients (age 19.2±2.0 years, range 16-25) transferred after growth completion from two pediatric clinics to adult endocrine unit. Two separate analyses were performed: 1) cross-sectional analysis of hormonal status, metabolic parameters, BC and BMD at first evaluation after transfer from pediatrics to adult department; 2) longitudinal analysis of BC and BMD dynamics after 3 years of GH replacement therapy (rhGH) in TP.
Results: COGHD was of a congenital cause (CONG) in 50.6% subjects, tumor related (TUMC) in 23.5% and idiopathic (IDOP) in 25.9%. TUMC patients had increased insulin and lipids levels (p<0.01) and lower Z score at L-spine (p<0.05) compared to CONG and IDOP groups. Patients treated with rhGH in childhood demonstrated lower fat mass and increased BMD compared to rhGH-untreated group (p<0.01). Three years of rhGH after growth completion resulted in significant increase in lean body mass (12.1%) and BMD at L-spine (6.9%), parallel with decrease in FM (5.2%).
Conclusion: The effect of rhGH in childhood is invaluable for metabolic status, BC and BMD in transition to adulthood. Tumor related COGHD subjects are at higher risk for metabolic abnormalities, alteration of body composition and decreased BMD, compared to those with COGHD of other causes. Continuation of rhGH in transition is important for improving BD and BMD in patients with persistent COGHD.
Approach to the Growth Hormone-Deficient Child during Transition to Adulthood
