Optimal strategy for management of pituitary disease in the growth hormone-deficient teenager.

The optimal treatment of chronic conditions spanning pediatric and adult clinical practice requires the establishment of clear and robust systems for managing the important period of transition of care. This principle is particularly relevant to the treatment of ongoing pituitary dysfunction after the achievement of final height and, in addition to the vital component of maintaining the confidence of the patient, encompasses a number of considerations that are particularly relevant to long-term health as an adult. These considerations include the achievement of peak bone mass, optimization of gonadal steroid and glucocorticoid replacement, and determination of the need for continuing growth hormone replacement. It is therefore necessary to consider these issues not only from the standpoint of therapeutic principles but also in the context of practical arrangements for managing the process of transition of care. Successful transition can be achieved using a variety of models, and there is clearly no single preferable option. The most important ingredient in this process is awareness of the situation by both pediatric and adult endocrinologists as well as the development of an agreed strategy within each clinical center.