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Diagnosis and treatment of growth hormone deficiency in adults

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.

Key Points

  • In addition to its effects on linear growth in childhood, growth hormone (GH) has many effects on metabolism, body composition, strength, aerobic capacity and mood that persist into adult life

  • Patients with adult GH deficiency have reduced muscle strength and energy, increased visceral adipose tissue mass, adverse lipid profiles, impaired quality of life and increased mortality

  • The diagnosis of adult GH deficiency requires GH provocative testing; however, only patients with a high pre-test probability of GH deficiency should be tested, because the tests lack specificity

  • Adult GH replacement therapy should be started at a weight-independent low dose and titrated up gradually to reach target levels of insulin-like growth factor 1 or to limit adverse effects

  • GH replacement therapy in adult patients with GH deficiency restores most biochemical and functional abnormalities to or toward normal, and is generally safe and well-tolerated when dosed appropriately

  • Most surveillance studies have shown no increase in cancer risk with adult GH treatment, but the limited duration of follow-up limits the strength of the reassurance they can provide

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Figure 1: Physiological regulation of GH secretion.
Figure 2: Main effects of GH replacement therapy in adult GH deficiency.

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Acknowledgements

The authors thank P. Asberry, S. Brickle, M. Kletke and L. Smith for their assistance with the work of the research group. The authors gratefully acknowledge research support from the National Institute of Aging, US National Institutes of Health, and from the facilities and resources of the US Department of Veterans Affairs Puget Sound Health Care System.

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A. Y. Kargi wrote the article and reviewed and edited the manuscript before submission. G. R. Merriam provided a substantial contribution to the discussion of content and reviewed and edited the manuscript before submission.

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G. R. Merriam receives or received research grant funding from Aeterna Zentaris, Eli Lilly, Prolor and Versartis, and is a consultant to Novo Nordisk and Teva. A. Y. Kargi declares no competing interests.

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Kargi, A., Merriam, G. Diagnosis and treatment of growth hormone deficiency in adults. Nat Rev Endocrinol 9, 335–345 (2013). https://doi.org/10.1038/nrendo.2013.77

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