Managing Growth Hormone Deficiency Across the Continuum of Care - Episode 14
Transitioning GHD Patients from Pediatric to Adult Care — Challenges and Best Practices
How to keep growth hormone deficiency patients on track when moving to adult care—cutting waitlists, dropouts, and insurance delays.
This episode addresses transition of care in GHD — widely recognized as one of the most clinically vulnerable periods for patients, with high rates of dropout and delayed or lost treatment.
Dr. Alter identifies the fundamental challenge from the pediatric side: finding adult endocrinologists with pituitary disease expertise and availability. Wait times for established pituitary specialists can stretch up to a year. His institution works proactively to cultivate relationships with adult endocrinologists across the Philadelphia region to ensure continuity.
Dr. Agrawal describes NYU’s collaborative approach: pediatric colleagues begin flagging patients for potential adult GH therapy as early as age 11–12, aiming for a smooth transition around ages 14–15. This advance communication allows time for retesting decisions, insurance prior authorizations, and documentation to be completed before treatment gaps occur.
A major concern raised by both Dr. Agrawal and Dr. Garcia is patient dropout. Patients who have formed trusted relationships with their pediatric endocrinologists are often reluctant to transfer care, and many are simply lost to follow-up. Those with structural pituitary disease face the most serious consequences if GH therapy lapses — including progressive weight gain, bone loss, and lean mass depletion.
The panel stresses the importance of beginning conversations about the adult role of GH early — before the patient stops growing. Patients often assume GHD ends with growth, so educating them that GH continues to support bone accrual (which peaks in the mid-20s) and body composition into adulthood is essential to sustaining motivation.
The panel recommends structured tools to facilitate transitions: patient handouts summarizing GH history and test results, and ideally a joint pediatric-adult transition clinic — a model not yet widely implemented but recognized as the gold standard.
In the next episode, “Navigating Insurance, Documentation, and Access Barriers in Adult GHD Management,” the panel examines the practical obstacles clinicians face in getting adult GHD therapy authorized and sustained, and strategies for overcoming them.
