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By Dr. Bernard Corenblum
Adult endocrinologist, based in Calgary, AB.
This article speaks to diagnosed growth hormone deficiencies. Other conditions treated with growth hormone are not included in this discussion.
Adolescence is a trying time for most people. Add growth hormone deficiency into the mix and things can get especially challenging. While some believe turning 18 marks the end of growth hormone injections, this will depend on what the doctor recommends.
While growth hormone (GH) plays an essential role in childhood growth and development, it doesn’t timeout when the biological clock strikes 18. With standard GH levels, an individual’s bones continue to get stronger and denser up until their mid to late twenties (at which point, bone development starts to decline).
Early adolescence, between the ages of 13 to 15, is a good time to talk with the pediatric endocrinologist about continuing GH therapy into adulthood. It’s also a good time to consider getting referred to an adult endocrinologist for future healthcare planning.
Growth hormone deficiencies are as unique as the individuals they affect. Each GH deficient child won’t necessarily be GH deficient as an adult, so everyone differs in terms of his or her future need for GH therapy. That’s why it’s imperative to get re-tested around the age of 18; an insulin tolerance test (ITT) or a glucagon stimulation test will help determine if GH therapy should be continued.
While maintaining a GH regimen is straightforward in theory, there are other complications that can arise in this “transition stage” of life. Things like new freedom, moving away from home, lack of health coverage and a general apathy toward future health can deter an adolescent from continuing GH therapy. This is why proper education, family support and professional advice are critical.
Whether or not your child continues on GH therapy, they should do their utmost to maximize bone health. Consuming a diet rich in calcium and vitamin D and staying fit and active are essential for bone maintenance.
There can be a social and/or emotional impact on those with growth hormone deficiency which can be can be very challenging for teenagers, who are already trying to manage all the changes associated with adolescence. Social impact can include such things as height restrictions at amusement parks which can make teenagers feel excluded because they can’t get on their rides that their peers are going on. Teenagers with GHD might have trouble participating in activities like sports or driving. It’s important that you discuss this with your healthcare team who will ensure that your teen is counseled and supported with the appropriate professional help.
If a decision is made by your doctor to discontinue treatment, your child will continue to be closely monitored. Things like DEXA scans (a technology used to measure bone density and body composition), waist measurements and even quality of life surveys may be useful and should occur on a regular basis, to determine if GH therapy should be resumed.
Transitioning to adulthood is inherently challenging—not to mention confusing—for adolescents, who are likely overwhelmed with lots of other life changes. That’s why education, treatment planning, getting retested, and maintaining a healthy lifestyle are critically important to ease this transition. By regularly communicating with healthcare professionals and making long term plans for continued treatment, adolescents will be better positioned to make a smooth transition.