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DOI: 10.1055/s-0029-1222579
© Georg Thieme Verlag KG Stuttgart · New York
Besonderheiten bei der Behandlung mit Wachstumshormon während des Übergangs vom Jugendlichen zum Erwachsenen (Transition)
Considerations of growth hormone treatment during the transition from adolescence to adulthoodPublikationsverlauf
eingereicht: 22.10.2008
akzeptiert: 26.2.2009
Publikationsdatum:
12. Mai 2009 (online)

Zusammenfassung
Bei Erwachsenen mit schwerem Wachstumshormonmangel orientieren sich die Ziele einer Ersatztherapie mit Wachstumshormon (WH) an den Effekten auf die Körperzusammensetzung, die körperliche Leistungsfähigkeit, den Knochenstoffwechsel, den Fettstoffwechsel und die Lebensqualität. Diese Prozesse müssen bei der Behandlung mit WH auch in der Übergangsphase (15. – 25. Lebensjahr) berücksichtigt werden, in der noch nicht alle Entwicklungsprozesse abgeschlossen sind. Eine Unterschreitung des Maximums der WH-Konzentration unter Standard-Stimulationsbedingungen unter 6 µg/l – im Gegensatz zu < 10 µg/l in der Kindheit und < 3 µg/l im Erwachsenenalter – wird in der Transitionsphase als WH-Mangel eingestuft. Die diagnostischen Strategien zur Verifizierung des WH-Mangels in der Übergangsphase, wie sie in internationalen Konsensuskonferenzen vorgeschlagen wurden, werden hier dargelegt. Wie beim Erwachsenen orientiert sich die WH-Dosierung (Startdosis 0,2 – 0,5 mg/Tag) an den individuellen Bedürfnissen und der IGF-I-Konzentration im Blut, welche über 1,0 SDS (Standard Deviation Score) aber unter 2,0 SDS der Norm liegen sollte. Die Betreuung in der Übergangsphase muss durch Endokrinologen erfolgen, die in der Adoleszenz und im Erwachsenenalter Expertise haben, und die Behandlung in strukturierter Form durchführen und dokumentieren.
Abstract
Growth hormone (GH) replacement treatment in adults with severe growth hormone deficiency is based on its known effects on body composition, physical performance, bone and lipid metabolism, and on improvements in the quality of life. These features must be taken into consideration when planning GH treatment of patients who are in the transition phase (aged between 15 and 25 years), because developmental stages may vary. GH deficiency during the transition phase is defined as GH levels under 6 µg/l in a standard stimulation test, compared to < 10 µg/l during childhood and < 3 µg/l during adulthood. We present an overview of the diagnostic strategies recommended at international consensus conferences on the verification ofGH deficiency during the transition phase. In analogy to the GH treatment of adults, the dosaging (dose at start = 0.2 – 0.5 mg/day) should be based on individual requirements as well as IGF-I concentrations in blood (> 1.0 SDS or < 2.0 SDS). GH treatment during the transition phase should be monitored by an endocrinologist with expertise in dealing with adolescent and adult patients, as well as having experience in structuring treatment and documentation.
Schlüsselwörter
Wachstumshormonmangel - Übergang zum Erwachsenen
Keywords
growth hormone deficiency - transitional phase
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Prof. Dr. med. M.B. Ranke
Universitätsklinik für Kinder- und
Jugendmedizin, Pädiatrische Endokrinologie und
Diabetologie
Hoppe-Seyler-Str. 1
72076 Tübingen
Telefon: 07071/29-83417
Fax: 07071/29-4157
eMail: michael.ranke@med.uni-tuebingen.de