A 15-year-old boy has been on recombinant human growth hormone (rhGH) for GH deficiency since age 7. His bone age is now 14 years, and his current height velocity is 2 cm/year. The pediatric endocrinologist is considering stopping GH therapy. Which criterion indicates that growth is essentially complete and rhGH therapy for GH deficiency in childhood can be discontinued for reassessment?

• A Bone age ≥17 years in boys (or 15 in girls) with epiphyseal fusion confirmed on hand X-ray ✓
• B Height velocity <2 cm/year AND bone age >14 years
• C Chronological age of 16 years regardless of bone age
• D IGF-1 level normalizes on current dose of rhGH

Explanation

Growth hormone therapy for childhood-onset GH deficiency is continued until near-adult height is achieved, defined as bone age ≥17 years in boys (≥15 years in girls) with near-complete epiphyseal fusion, or when the height velocity falls below 2 cm/year AND the bone age is advanced. Epiphyseal fusion on hand X-ray is the objective endpoint. After cessation, patients with childhood-onset GH deficiency must be re-tested as adults (transition), as up to 70% will not meet criteria for adult GH deficiency and GH therapy has different indications (metabolic effects) in adults.

Reference: Ghai Essential Pediatrics, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.