Diagnosis and Treatment of Growth Hormone Deficiency in Adults

Overview

Journal Nat Rev Endocrinol

Specialty Endocrinology

Date 2013 May 1

PMID 23629539

Citations 41

Authors

Atil Y Kargi

George R Merriam

Affiliations

Soon will be listed here.

Abstract

The availability of synthetic recombinant human growth hormone (GH) in potentially unlimited quantities since the 1980s has improved understanding of the many nonstatural effects of GH on metabolism, body composition, physical and psychological function, as well as the consequences of GH deficiency in adult life. Adult GH deficiency is now recognized as a distinct if nonspecific syndrome with considerable adverse health consequences. GH replacement therapy in lower doses than those used in children can reverse many of these abnormalities and restore functional capacities toward or even to normal; if dosed appropriately, GH therapy has few adverse effects. Although some doubts remain about possible long-term risks of childhood GH therapy, most registries of adult GH replacement therapy, albeit limited in study size and duration, have not shown an increased incidence of cancers or of cardiovascular morbidity or mortality.

Citing Articles

Hypopituitarism presenting with cardiovascular manifestations: a case report.

Zhen X, Li Y, Ren C, Li M BMC Cardiovasc Disord. 2025; 25(1):117.

PMID: 39972417 PMC: 11837320. DOI: 10.1186/s12872-025-04535-9.

Potential causal association of diabetes mellitus and blood glucose related indexes with the onset of epilepsy: a two-sample Mendelian randomization study.

Zhu M, Ling S Front Neurol. 2024; 15:1399504.

PMID: 38962478 PMC: 11221190. DOI: 10.3389/fneur.2024.1399504.

The somatotroph pituitary gland function in high-aged multimorbid hospitalized patients with IGF-I deficiency.

Tausendfreund O, Bidlingmaier M, Martini S, Reif H, Rippl M, Schilbach K Pituitary. 2024; 27(5):480-487.

PMID: 38819617 PMC: 11513707. DOI: 10.1007/s11102-024-01406-y.

Morbidities and mortality among hospitalized patients with hypopituitarism: Prevalence, causes and management.

Ebrahimi F, Andereggen L, Christ E Rev Endocr Metab Disord. 2024; 25(3):599-608.

PMID: 38802643 PMC: 11162375. DOI: 10.1007/s11154-024-09888-8.

Effects of the Pituitary-targeted Gland Axes on Hepatic Lipid Homeostasis in Endocrine-associated Fatty Liver Disease-A Concept Worth Revisiting.

Li Y, Zheng M, Limbara S, Zhang S, Yu Y, Yu L J Clin Transl Hepatol. 2024; 12(4):416-427.

PMID: 38638376 PMC: 11022059. DOI: 10.14218/JCTH.2023.00421.

References

Stochholm K, Gravholt C, Laursen T, Laurberg P, Andersen M, Kristensen L . Mortality and GH deficiency: a nationwide study. Eur J Endocrinol. 2007; 157(1):9-18. DOI: 10.1530/EJE-07-0013. View

Agha A, Rogers B, Sherlock M, OKelly P, Tormey W, Phillips J . Anterior pituitary dysfunction in survivors of traumatic brain injury. J Clin Endocrinol Metab. 2004; 89(10):4929-36. DOI: 10.1210/jc.2004-0511. View

Klose M, Juul A, Struck J, Morgenthaler N, Kosteljanetz M, Feldt-Rasmussen U . Acute and long-term pituitary insufficiency in traumatic brain injury: a prospective single-centre study. Clin Endocrinol (Oxf). 2007; 67(4):598-606. DOI: 10.1111/j.1365-2265.2007.02931.x. View

Drake W, Rodriguez-Arnao J, Weaver J, James I, Coyte D, Spector T . The influence of gender on the short and long-term effects of growth hormone replacement on bone metabolism and bone mineral density in hypopituitary adults: a 5-year study. Clin Endocrinol (Oxf). 2001; 54(4):525-32. DOI: 10.1046/j.1365-2265.2001.01246.x. View

Rosen T, Bengtsson B . Premature mortality due to cardiovascular disease in hypopituitarism. Lancet. 1990; 336(8710):285-8. DOI: 10.1016/0140-6736(90)91812-o. View

Al-Shoumer K, Page B, Thomas E, Murphy M, Beshyah S, Johnston D . Effects of four years' treatment with biosynthetic human growth hormone (GH) on body composition in GH-deficient hypopituitary adults. Eur J Endocrinol. 1996; 135(5):559-67. DOI: 10.1530/eje.0.1350559. View

Vestergaard P, Hoeck H, Jakobsen P, Laurberg P . Reproducibility of growth hormone and cortisol responses to the insulin tolerance test and the short ACTH test in normal adults. Horm Metab Res. 1997; 29(3):106-10. DOI: 10.1055/s-2007-979000. View

Colao A, Di Somma C, Spiezia S, Savastano S, Rota F, Savanelli M . Growth hormone treatment on atherosclerosis: results of a 5-year open, prospective, controlled study in male patients with severe growth hormone deficiency. J Clin Endocrinol Metab. 2008; 93(9):3416-24. DOI: 10.1210/jc.2007-2810. View

Cuneo R, Salomon F, McGauley G, Sonksen P . The growth hormone deficiency syndrome in adults. Clin Endocrinol (Oxf). 1992; 37(5):387-97. DOI: 10.1111/j.1365-2265.1992.tb02347.x. View

10.

Aimaretti G, Corneli G, Razzore P, Bellone S, Baffoni C, Arvat E . Comparison between insulin-induced hypoglycemia and growth hormone (GH)-releasing hormone + arginine as provocative tests for the diagnosis of GH deficiency in adults. J Clin Endocrinol Metab. 1998; 83(5):1615-8. DOI: 10.1210/jcem.83.5.4837. View

11.

Moock J, Albrecht C, Friedrich N, Volzke H, Nauck M, Koltowska-Haggstrom M . Health-related quality of life and IGF-1 in GH-deficient adult patients on GH replacement therapy: analysis of the German KIMS data and the Study of Health in Pomerania. Eur J Endocrinol. 2008; 160(1):17-24. DOI: 10.1530/EJE-08-0738. View

12.

Gotherstrom G, Bengtsson B, Bosaeus I, Johannsson G, Svensson J . A 10-year, prospective study of the metabolic effects of growth hormone replacement in adults. J Clin Endocrinol Metab. 2007; 92(4):1442-5. DOI: 10.1210/jc.2006-1487. View

13.

Molitch M, Clemmons D, Malozowski S, Merriam G, Vance M . Evaluation and treatment of adult growth hormone deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011; 96(6):1587-609. DOI: 10.1210/jc.2011-0179. View

14.

van der Klaauw A, Biermasz N, Feskens E, Bos M, Smit J, Roelfsema F . The prevalence of the metabolic syndrome is increased in patients with GH deficiency, irrespective of long-term substitution with recombinant human GH. Eur J Endocrinol. 2007; 156(4):455-62. DOI: 10.1530/EJE-06-0699. View

15.

van der Lely A, Tschop M, Heiman M, Ghigo E . Biological, physiological, pathophysiological, and pharmacological aspects of ghrelin. Endocr Rev. 2004; 25(3):426-57. DOI: 10.1210/er.2002-0029. View

16.

Toogood A, Shalet S . Diagnosis of severe growth hormone (GH) deficiency in young adults who received GH replacement therapy during childhood. Acta Paediatr Suppl. 1997; 423:117-20. DOI: 10.1111/j.1651-2227.1997.tb18390.x. View

17.

Bravenboer N, Holzmann P, de Boer H, Blok G, Lips P . Histomorphometric analysis of bone mass and bone metabolism in growth hormone deficient adult men. Bone. 1996; 18(6):551-7. DOI: 10.1016/8756-3282(96)00069-5. View

18.

RABEN M . Growth hormone. 1. Physiologic aspects. N Engl J Med. 1962; 266:31-5. DOI: 10.1056/NEJM196201042660109. View

19.

Holmes S, Economou G, Whitehouse R, Adams J, Shalet S . Reduced bone mineral density in patients with adult onset growth hormone deficiency. J Clin Endocrinol Metab. 1994; 78(3):669-74. DOI: 10.1210/jcem.78.3.8126140. View

20.

Woodhouse L, Mukherjee A, Shalet S, Ezzat S . The influence of growth hormone status on physical impairments, functional limitations, and health-related quality of life in adults. Endocr Rev. 2006; 27(3):287-317. DOI: 10.1210/er.2004-0022. View