Transfer to adult care for patients with complex conditions of paediatric origin is challenging . Patients wish for health care by clinicians familiar with issues /risks, assurance of privacy, together with clinics suited to study and work. Where family oversight has been necessarily vigilant as with hypothalamic pituitary (HP) disorders , families have concerns as to continuity of care, judgement as to readiness and capacity of the adolescent to take on the burden of independence, ability of a new provider to recognize specific needs, particularly in areas of contraception, evolution of fertility issues, risk taking, compliance and loss to follow up.
Congenital HP disorders may be relatively stable but evolving need for fertility requires detailed knowledge of gonadotropin use. Pregnancy, parturition stress cover and breast feeding ability may need to be introduced, as unlikely to have been covered by paediatricians. Acquired HP disorders are most commonly related to childhood cancer and cranial/ craniospinal irradiation, needing ongoing surveillance for evolving gonadal failure, combined primary plus secondary hypogonadism with different fertility issues including cardiac risk, thyroid cancer surveillance, physical instability with posterior fossa syndrome needing growth hormone , evolving breast, skin and bowel risks, chronic neck pain and evolving hearing loss. Although many of these problems are not strictly endocrine , the endocrinologist is almost always the most constant and recurrent medical attendant and becomes responsible for surveillance and direction to appropriate providers. The key feature for the adult endocrinologist is to understand the long term adverse effects of memory processing and concentration for these patients, reducing capacity to grasp and retain information and thus reduce compliance, with rare further risks for later accelerated dementia in a small group.
Further discussion of specific issues of diabetes insipidus associated risks, extended hypothalamic damage with absent thirst , anosmia, steroid and growth hormone dosing, long term hCG vs testosterone challenges will be covered briefly if different from standard adult care.