Table 2.

Recommendations for endocrinologic problems in Prader-Willi syndrome (PWS)

Endocrine problems	Age of life	Screening and monitoring	Managements
Growth hormone deficiency	Early infancy	Monitoring of growth according to disease-specific growth curve	GHT start as diagnosis of PWS is made (as early as 3–6 months of age)
	Childhood and adolescence	Monitoring of growth, skeletal maturation, puberal development.	GHT start as soon as possible after PWS diagnosis or continue GHT with monitoring
		If sleep apnea is developed, adenoid assessment and polysomnography are needed.
		Regular assessment of anthropometric measure, IGF-1, TFT, glucose metabolism, scoliosis
	Adulthood	Assessment of IGF-1, lipid and glucose metabolism, BMI, lean body mass	Considering restart GHT with confirmed GHD after achievement of final height
Hypothyroidism	Early infancy	TFT within first 3 months of age	Levothyroxine supplement at typical replacement dose
	After childhood	TFT annually, or every 6 months during GHT
Central adrenal insufficiency	All age	Educate patients and their families on signs and symptoms of adrenal insufficiency	Hydrocortisone supplement at typical replacement dose
		Consider adrenal function test at presenting clinical features or prior to major surgery or anesthesia
Hypogonadism	Newborn and early infancy	Examination for cryptorchidism in male	Orchiopexy in most case
	Childhood and adolescence	Monitoring of pubertal initiation and progression	If delayed or stalled puber ty, consider sex hormones replacement therapy
		Assessment of LH, FHS, testosterone/estradiol, inhibin B	Consider sex hormones replacement therapy
	Adulthood	Assessment of LH, FHS, testosterone/estradiol, inhibin B	Counsel for contraception in female

GHT, growth hormone treatment; IGF-1, insulin like growth factor-1; BMI, body mass index; TFT, thyroid function test.