SAT-LB11 Adult Growth Hormone Deficiency Transition Care From Pediatric to Adult Services: Insights From a US Advisory Board
Authors: Yuen Kevin C J , Alter Craig A , Miller Bradley Scott , Gannon Anthony W , Tritos Nicholas A , Samson Susan Leanne , Dobri Georgiana Alina , Kurtz Kristine , Strobl Frank , Kelepouris Nicky 
Published: May 2020

Background: Transition care of patients with childhood-onset GH deficiency (CO-GHD) who were treated with GH during childhood remains an ongoing challenge with substantial variation in coordination of care, clinical assessment, and management among pediatric and adult services. Despite the availability of clinical guidelines providing a framework for transition care of adolescents with CO-GHD, many patients discontinue therapy during the transition phase. Methods: A panel of pediatric and adult US endocrinologists with extensive experience in treating transition patients convened in October 2019 as part of an advisory board to address current clinical unmet needs and to share learnings based on a structured transitional plan to strive for optimal management of these patients. Results: It is acknowledged that pediatric endocrinologists play a crucial role in initiating the transition process, which involves close communication and direct collaboration between pediatric and adult services to reduce delays in identifying patients and resuming GH therapy in adulthood; adult endocrinologists need to increase their awareness of the importance of potential benefits and extent of long-term safety of GH therapy in adult patients. There is also a need for consensus guidelines or a white paper that focuses on transition care and endorsed by pediatric and adult organizations. Because not all patients with CO-GHD will have persistent GHD as adults, there is a need to improve the identification and timely retesting of those who will require continuity of GH therapy into adulthood. An increase in accessibility for retesting and guidance on appropriate GH dosing once persistent GHD is confirmed are other important factors. Certain subpopulations of pediatric patients (e.g., cancer survivors; patients with congenital hypopituitarism, optic nerve hypoplasia, treated sellar masses, and traumatic brain injury) should be prioritized in determinations of when and how retesting should be performed. The viewpoints of both pediatric and adult endocrinologists were presented at this meeting, and comprehensive considerations and suggestions were discussed. Conclusion: Transition care of patients with CO-GHD requires a collaborative multidisciplinary approach to ensure continuity of care between pediatric and adult services and to improve bone health and reduce long-term cardiometabolic risks. The major challenge is to effectively ensure that transition patients are retested and offered adult GH therapy without delay. Current guidelines should be more focused on transition patients, addressing key areas of uncertainty as evidenced by variable clinical practices. A clearly structured transition protocol is vital, and these insights provide useful, practical guidance to clinicians to establish best practices when transitioning adolescents with persistent CO-GHD to adult services.