Monitoring

Growth should be monitored on age- and sex-appropriate growth charts. On average, puberty contributes 20-25 cm of height in females and 25-30 cm in males, and this is dependent on adequate GH and insulin-like growth factor 1 (IGF1) concentrations. Monitoring of patients with an acquired cause of growth hormone deficiency (GHD; e.g., tumours, radiation, and infiltrative disorders) will depend on the individual condition. All patients on GH treatment need to be monitored and continue receiving treatment until final height or epiphyseal closure is achieved.[59]

Patients also should be monitored for hypothyroidism and adrenal insufficiency as GH treatment increases metabolism of thyroid hormone and cortisol and may unmask these conditions.[67]​ Neonates with isolated GHD (IGHD) or CPHD will require long-term follow-up to detect early evolving endocrinopathies and optimise treatment.

Endocrine reassessment should be undertaken after completion of growth and puberty in patients with idiopathic isolated GHD and GHD with only one additional pituitary hormone deficit to identify adults with ongoing GHD and ascertain the need for adult GH replacement.[42][99][100] In 25% to 75% of patients, the GH response to provocation is in the normal range.[101] The reasons for this reversal of GHD are unclear. For patients with GHD due to acquired hypothalamo-pituitary damage (e.g., from a craniopharyngioma), known genetic mutations causing hypopituitarism, widespread mid-line structural brain defects, or ≥3 other pituitary hormone deficits, re-testing may not be mandatory.

Pituitary hormone deficiencies can evolve with time, so regular monitoring, both clinically and with regular biochemical investigations, is needed.

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