AUTHOR=Mericq Veronica , Iñiguez German , Pinto Graziella , Gonzalez-Briceño Laura G. , Samara-Boustani Dinane , Thalassinos Caroline , Flechtner Isabelle , Stoupa Athanasia , Beltrand Jacques , Besançon Alix , Brabant Séverine , Ghazal Khaldoun , Leban Monique , Touraine Philippe , Cavada Gabriel , Polak Michel , Kariyawasam Dulanjalee 

TITLE=Identifying patient-related predictors of permanent growth hormone deficiency

JOURNAL=Frontiers in Endocrinology

VOLUME=Volume 14 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2023.1270845

DOI=10.3389/fendo.2023.1270845

ISSN=1664-2392

ABSTRACT=Objective: Isolated childhood growth hormone deficiency (GHD) can persist into adulthood, and re-testing at the transition period is needed to determine whether continued growth hormone therapy is indicated. Here, our objective was to identify predictors of permanent GHD.  
Design: Retrospective single-centre study of patients with childhood-onset GHD who were re-tested after adult height attainment.
Methods: Auxological, clinical, laboratory, and MRI data throughout follow-up were collected. 
Results: We included 101 patients. At GH treatment initiation, age was 8.1±0.4 years, height -2.25±0.8, and BMI -0.27±0.1 SDS. The 29 (28.7%) patients with persistent GHD had lower height SDS (-2.57±0.1 vs. -2.11±0.1, p<0.001) and mean GH peaks (8.4±1.0 vs.13.2±0.5 mIU/L, p<0.001) at GHD diagnosis; at adult height, they had lower IGF1 (232±19.9 vs. 331±9.1 ng/mL, p<0.001) and higher BMI SDS (-0.15±0.27 vs. -0.73±0.13, p<0.005). By multivariate analysis, the best predictive model included height and BMI SDS, both GH peaks, and MRI findings at diagnosis. Patients with height at diagnosis <-3 SDS had a 7.7 (95% IC 1.4-43.1, p=0.02) fold higher risk of persistent GHD after adjustment on BMI SDS. An abnormal pituitary region by MRI was the strongest single predictor (7.2 times, 95% CI 2.7-19.8) and after multivariate analysis adjustment for GH peaks and height SDS at diagnosis, the risk increased to 10.6 (1.8 - 61.3) times.
Conclusions: Height <-3 SDS at GHD diagnosis and pituitary MRI abnormalities should lead to a high index of suspicion for persistent GHD.