What Specialty Can Prescribe Peptides
Endocrinologists are the primary specialists who prescribe peptide hormones like somatropin (growth hormone), with pediatric endocrinologists managing children and adult endocrinologists managing adults with growth hormone deficiency. 1, 2
Primary Prescribing Specialists
Pediatric Patients
- Pediatric endocrinologists with expertise in pituitary disorders should coordinate all peptide hormone therapy in children, including growth hormone replacement 1
- Management requires specialist centers with multidisciplinary teams including pediatric endocrinology, neurosurgery, oncology, and radiation oncology 1
- For complex cases involving pituitary adenomas or multiple hormone deficiencies, consultation with adult pituitary specialists is essential 1
Adult Patients
- Adult endocrinologists specializing in pituitary disorders prescribe growth hormone for adult-onset or childhood-onset growth hormone deficiency that persists into adulthood 2
- Patients transitioning from pediatric to adult care require close coordination between pediatric and adult endocrine services 1
Specific Clinical Contexts
Growth Hormone Deficiency
- Somatropin is FDA-approved for both pediatric growth failure (due to inadequate endogenous GH, Prader-Willi Syndrome, small for gestational age, Turner Syndrome, and idiopathic short stature) and adult GH deficiency 2
- Therapy must be supervised by physicians experienced in diagnosing and managing these specific conditions 2
Pituitary Disorders
- Children and adolescents with pituitary adenomas require management by specialist age-appropriate endocrine and neuro-oncology centers 1
- Access to national pediatric pituitary-specific advisory panels is recommended for complex cases 1
- For Cushing disease in remission, prompt GH replacement should be initiated if deficiency is proven, coordinated by pediatric endocrinologists 1
Important Caveats
Prerequisite Hormone Replacement
- Before initiating growth hormone therapy, adequate glucocorticoid and thyroid hormone replacement must be established first to prevent complications such as adrenal crisis 3
- This is particularly critical in patients with panhypopituitarism or multiple pituitary hormone deficiencies 3
Diagnostic Requirements
- Confirmation of GH deficiency requires appropriate provocative testing, except in patients with multiple pituitary hormone deficiencies due to organic disease or congenital/genetic GH deficiency 2, 4
- Patients with 3 or more pituitary hormone deficiencies do not require dynamic testing before treatment initiation 3