Adherence to growth hormone therapy: a practical approach.

Background: Early detection of suspected poor adherence to growth hormone (GH) therapy is crucial to achieve normal final height in GH- deficient (GHD) patients. Patients: 106 children (73 M, 33 F) with a median age of 10.47 +/- 3.48 years (mean +/- standard deviation score (SDS)) exhibited short stature (-1.76 +/- 0.64 SDS) and a delayed bone age (8.68 +/- 3.42 years). Severe GHD was found in 28, while partial GHD was seen in 78 cases, with low IGF- I values. Recombinant human GH was administered by daily subcutaneous injection at a dosage of 21 mu g/ kg in prepubertal and 25 mu g/ kg in pubertal patients. Results: Poor adherence was suspected in a number of patients, but clearly demonstrated in only 4 cases with persistent reduced height velocity in spite of a corrected therapeutic regimen. These patients admitted incomplete adherence to GH injections and clinical and anthropometric measurements revealed their poor response to therapy. Conclusions: To efficaciously improve adherence in GHD patients, it is mandatory to regularly interview patients; a non- aggressive approach might be utilized to ensure effective communication with patients and their parents.