Figure 1.

Schema for assessing the GH/IGF-1 axis during the transition period.

Notes: Areas of uncertainty: 1) who should have their GH axis reevaluated and who is responsible, pediatric or adult endocrinologist? 2) what is the optimal duration for washout? 3) what are the criteria for low and high risk of persistent GHD? 4) those with a high risk of persistence GHD, do they still require reevaluation or should they continue GH therapy? 5) what is the GH peak cutoff? 6) when and where to follow up those who no longer have GHD? 7) monitoring and the outcome of second reevaluation at age 25 and 8) what if patient declines GH therapy? Adapted with permission from the European Journal of Endocrinology, from Clayton PE, Cuneo RC, Juul A, Monson JP, Shalet SM, Tauber M. European Society of Paediatric Endocrinology. Consensus statement on the management of the GH-treated adolescent in the transition to adult care. Eur J Endocrinol. 2005;152(2):165–170. Copyright 2018. Permission conveyed through Copyright Clearance Center, Inc.2

Abbreviations: GH, growth hormone; GHD, growth hormone deficiency; MRI, magnetic resonance imaging; PBM, peak bone mass.