Endocrinol Metab.  2022 Apr;37(2):359-368. 10.3803/EnM.2021.1384.

Metabolic Impacts of Discontinuation and Resumption of Recombinant Human Growth Hormone Treatment during the Transition Period in Patients with Childhood-Onset Growth Hormone Deficiency

• Lee YJ
• Choi Y
• Yoo HW
• Lee YA
• Shin CH
• Choi HS
• Kim HS
• Kim JH
• Moon JE
• Ko CW
• Ahn MB
• Suh BK
• Choi JH

• KMID: 2529227
• DOI: http://doi.org/10.3803/EnM.2021.1384

Abstract

Background
Discontinuing growth hormone (GH) treatment during the transition to adulthood has been associated with adverse health outcomes in patients with childhood-onset growth hormone deficiency (CO-GHD). This study investigated the metabolic changes associated with interrupting GH treatment in adolescents with CO-GHD during the transition period.
Methods
This study included 187 patients with CO-GHD who were confirmed to have adult GHD and were treated at six academic centers in Korea. Data on clinical parameters, including anthropometric measurements, metabolic profiles, and bone mineral density (BMD) at the end of childhood GH treatment, were collected at the time of re-evaluation for GHD and 1 year after treatment resumption.
Results
Most patients (n=182, 97.3%) had organic GHD. The median age at treatment discontinuation and re-evaluation was 15.6 and 18.7 years, respectively. The median duration of treatment interruption was 2.8 years. During treatment discontinuation, body mass index Z-scores and total cholesterol, low-density lipoprotein, and non-high-density lipoprotein (HDL) cholesterol levels increased, whereas fasting glucose levels decreased. One year after GH treatment resumption, fasting glucose levels, HDL cholesterol levels, and femoral neck BMD increased significantly. Longer GH interruption (>2 years, 60.4%) resulted in worse lipid profiles at re-evaluation. The duration of interruption was positively correlated with fasting glucose and non-HDL cholesterol levels after adjusting for covariates.
Conclusion
GH treatment interruption during the transition period resulted in worse metabolic parameters, and a longer interruption period was correlated with poorer outcomes. GH treatment should be resumed early in patients with CO-GHD during the transition period.

Keyword

Adolescent; Body mass index; Bone density; Dyslipidemias; Growth hormone; Pituitary gland; Transition to adult care

Figure

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  Fig. 1. Peak growth hormone (GH) levels on GH stimulation tests at re-evaluation according to the underlying etiologies of childhood-onset growth hormone deficiency (CO-GHD).

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