Management options for pediatric growth hormone deficiency

ABSTRACTIntroduction: Growth hormone deficiency (GHD), in 1:4000 children, is congenital or acquired inability to produce serum GH from the pituitary. Management of pediatric GHD is evolving and requires review.Areas covered: Controversies about GHD continue regarding diagnostic criteria, referral criteria, testing, optimal treatment, safety, monitoring, and management during transition to adulthood. Efforts are ongoing to improve efficacy of GH therapy, including prolonging growth by delaying puberty, and once weekly preparations. Early diagnosis of GHD permits starting GH at a young age, normalizing height while keeping mid-normal IGF-I levels. After completion of linear growth, young adults with childhood-onset GHD are unlikely to re-start GH therapy unless the re-start is supervised by the pediatric endocrinologist, or unless the adult provider has experience with pituitary endocrinology.Expert opinion: GH replacement therapy for GHD has benefits for growth (in childhood) and for body composition, hem...