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  GH deficiency
 
Author: Roberto Salvatori Last modified: December 11, 2001
DIAGNOSTIC CRITERIA

  EPIDEMIOLOGY

  • Adult GH deficiency occurs in patients with hypothalamic and pituitary pathology. 50% of children diagnosed with idiopathic isolated GH deficiency are no longer deficient as adults
  • Exact prevalence difficult to determine. However, in patients with pituitary disease, GH secretion is usually the first pituitary function to fail
  • The likelihood of a patient who is missing all the other pituitary hormones of being GH deficient is 100%

  RISK FACTORS

  • Neoplastic, ischemic or inflammatory diseases of the hypothalamus or the pituitary gland
  • Brain irradiation
  • Aging (starting in the late 20's) is a physiological cause of progressive partial reduction of GH secretion

  SIGNS AND SYMPTOMS

  • If present in childhood it causes growth failure. Some adults experience no subjective symptoms, others notice fatiguability, exhaustion, reduced interest in life activities, and social withdrawness
  • The physician may notice increase in serum total and LDL cholesterol, reduced bone mineral density and increased systolic blood pressure

  LABORATORY FINDINGS

  • Most of the times the diagnosis is made with GH stimulation tests, with measurament of serum GH response to different stimuli (e.g. GHRH, Arginine, or insulin)
  • Serum IGF-1 is often used, but it is a poorly sensitive tests, particularly in older patients. However a frankly low IGF-1 in the setting of hypopituitarism is strongly suggestive of GH deficiency

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TREATMENT
SYNTHETIC HUMAN GH INJECTED UNDER THE SKIN DAILY
  • injection devices similar to the ones available for insulin (extra fine needles, pens) are available
  • In the next future slow-release preparations injectable once or twice a month may be available

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IMPORTANT POINTS/RECOMMENDATIONS
  • GH treatment is reserved for patients with proven GH deficiency and should not be used to increase physical performances or to prevent aging
  • Although GH treatment of GH-deficient adults seems safe in the short-term, no long-term data on its safety is presently available

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REFERENCES
  1. Bengtsson BA, Johannsson G, Shalet SM, Simpson H, Sonken PH ;  Treatment of growth hormone deficiency in adults ;  J Clin Endocrinol Metab 2000 Mar;85(3):933-42

    Comment:
    Comprehensive review of the diagnostic criteria, therapeutical indications and modalities, side effects and contraindications of GH therapy in adults from several Europen experts in the field

  2. Vance ML, Mauras N. ;  Growth hormone therapy in adults and children ;  N Engl J Med 1999 Oct 14;341(16):1206-16

    Comment:
    Review of the state of the art indications of GH treatment in children and adults from an adult and a pediatric endocrinologist

  3. Growth Hormone Research Society ;  Consensus guidelines for the diagnosis and treatment of adults with GH deficiency ;  J Clin Endocrinol Metab 83 (2): 379-381, 1998

    Comment:
    Official consensus statement on diagnosis and treatment guidelines for GH deficiency in adults

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