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Transition from Puberty to Adulthood

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Growth Hormone Related Diseases and Therapy

Part of the book series: Contemporary Endocrinology ((COE))

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Abstract

Growth hormone deficiency (GHD) has implications throughout the lifespan. In childhood, reduced linear growth is the primary consequence of untreated GHD, while in adulthood, a number of abnormalities are associated with the phenotype of untreated GHD. However, the phenotype of GHD in adulthood differs depending on timing of onset. Childhood-onset (CO) patients have reduced bone mineral content and lean body mass despite GHRT during childhood. These differences suggest the CO GHD phenotype is developmental. It is these developmental deficits that have led to a focus on GHRT in patients with CO GHD in the transition period, spanning from the completion of puberty into young adulthood. The aim of GHRT during this time is to normalise body composition and cardiovascular health with the long-term aim of reducing the morbidity and mortality observed in patients with hypopituitarism. There is evidence that GHRT at this time aids to reduce this deficit in muscle and bone. This may have the effect of improving physical performance and reducing fractures later in life; however, the epidemiological evidence is currently lacking. There is inconsistent evidence that cardiovascular risk is increased and quality of life (QoL) is reduced and that these improve with GHRT. It is possible, and there is some evidence to support this, that certain patient groups may demonstrate a worsening cardiovascular risk profile and QoL after a more sustained period of time off GHRT. More studies are required to provide the endocrinologist and the patient with adequate information to inform treatment decisions. It is essential that both paediatric and adult endocrinologists recognise that young people with GHD are young people first and foremost. Addressing the psychological, social, educational, and vocational needs of young people is essential in engaging them in their ongoing management with GHD.

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  1. Department of Endocrinology, Leicester Royal Infirmary, Leicester, LE1 5WW, UK

    Helena Gleeson

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    Ken Ho

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Gleeson, H. (2011). Transition from Puberty to Adulthood. In: Ho, K. (eds) Growth Hormone Related Diseases and Therapy. Contemporary Endocrinology. Humana Press. https://doi.org/10.1007/978-1-60761-317-6_10

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