Growth%20hormone%20deficiency Management

Adults

• Monitor monthly initially for response to treatment and adjust dose accordingly
• Plasma glucose should be checked initially and every 3 months
• Once maintenance doses are achieved, measurement of serum fasting blood sugar (FBS), insulin-like growth factor 1 (IGF-1), hemoglobin A1c (HbA1c), waist circumference, body mass index (BMI), serum free T₄, and clinical assessment of hypothalamic-pituitary-adrenal axis or by early morning cortisol or cosyntropin stimulation test (in patients not on glucocorticoid replacement), testosterone, and fasting lipid panel should be done every 6-12 months
• DEXA (Dual Energy X-ray Absorptiometry) scan is recommended prior to and during growth hormone (GH) therapy
  
  • 1st DEXA scan after initiation of GH replacement should be done at approximately 2 years later and repeated at 2-3 year intervals
• MRI is recommended at baseline in patients with any postsurgical tumor remnant in the hypothalamic-pituitary region before starting GH therapy
  • Periodic MRI is recommended while on GH therapy

Children

• Close follow-up care with an endocrinologist is recommended to monitor the child’s growth, assessment of potential adverse effects, and to adjust the dose of GH therapy
• Initial follow-up should be every month; thereafter, visits may be less frequent but should be at least 2x/year
• Monitor every 3-6 months for response to treatment and adjust dose accordingly
• Monitor thyroid function every 6 months
• Continue GH therapy if there is persistent growth hormone deficiency (GHD) even after adult height is achieved to obtain full skeletal/muscle maturation during the transition period
• GHD may persist to adult life
  
  • Retesting may be required esp in idiopathic GHD patients (retest using adult criteria after 1-3 months without GH therapy)