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Growth Hormone Deficiency

GHD

Growth hormone deficiency may occur in a myriad of conditions, including genetic, malignant and trauma, with short stature and increased adiposity being the main clinical features. An extensive diagnostic workup is necessary to confirm GH deficiency and determine the underlying cause. The mainstay of therapy is human recombinant growth hormone and life-long therapy is recommended.

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Presentation

Signs such as increased body fat and waist-hip ratio, reduction in lean body mass, low muscle strength and endurance are some of the findings seen in GHD patients [11]. An evidently short stature for appropriate age or reduced height velocity over the course of few years and neurological deficits that may point to intracranial lesions (anosmia or visual deficits) are findings that require exclusion of GHD as the underlying cause, while neonatal signs include prolonged jaundice, microcephaly and hypoglycemia [3].

Short Stature
  • Short stature is one of the clinical manifestations in these children. Although polyuria, polydipsia, hypokalemia, and salt loss may be responsible for growth retardation, the exact pathogenesis of short stature in Bartter syndrome is not known.[ncbi.nlm.nih.gov]
Pain
  • The second one aged 34 with impaired fasting glycemia and without any sign of GHD presented with sudden calf pain as a result of tibial posterior arterial acute occlusion.[ncbi.nlm.nih.gov]
  • If the person is getting too much growth hormone, he or she will have muscle or joint pain, swelling (fluid retention) and pain or numbness in the hands from carpal tunnel syndrome.[cedars-sinai.edu]
  • The most common side effects reported are: An injection site reaction such as pain, numbness, redness, and swelling Muscle and joint pain Tingling and numbness Unusual skin sensations Headache Adults also commonly report swelling associated with fluid[saizenus.com]
  • Joint pains. 3. Muscle pains. 4. Tingling, numbness, usually at the wrist. 5. Carpal tunnel syndrome. 6. Headache. These side-effects are usually due to a large initiating dose of growth hormone and usually subsides by reducing the dose.[onlinemedinfo.com]
  • Nutropin therapy has not been shown to increase the occurrence of this condition Increases in laboratory test serum levels of inorganic phosphorus, alkaline phosphatase, parathyroid hormone (PTH), or IGF-1 Abdominal pain.[nutropin.com]
Fatigue
  • CASE PRESENTATION: Here, we describe a 17-year old boy referred to our hospital for fatigue, decreased muscle strength and severe headache reported after the cessation of rhGH treatment for a GH deficiency diagnosed at the age of 2 years and 3 months.[ncbi.nlm.nih.gov]
  • Three cytokines, IL-1, IL-6, and IL-8, cause severe widespread pain, fatigue and disturbed sleep. IL-6 is related to fatigue and impaired concentration.[worldhealth.net]
  • Of these, the most frequently cited were sleep troubles, and fatigue. Respondents had difficulty falling asleep or sleeping through the night, and were deeply fatigued during the day.[bmcresnotes.biomedcentral.com]
  • Adults with growth hormone deficiency may experience symptoms that include fatigue, emotional changes, and muscle and body fat changes. Managing Growth Hormone Deficiency Management often depends on the cause of the deficiency.[lumicera.com]
Weight Gain
  • We diagnosed GHD at age 8 yr 8 months because of growth deceleration (from 95 to 25%) and abnormal growth rate (3 cm/yr) despite euthyroidism, fair glycemic control, and normal weight gain.[ncbi.nlm.nih.gov]
  • gain, especially around the waist Understanding Growth Hormone Deficiency It's important to understand that not everyone with growth hormone deficiency will have the same symptoms.[endocrineweb.com]
Swelling
  • If the person is getting too much growth hormone, he or she will have muscle or joint pain, swelling (fluid retention) and pain or numbness in the hands from carpal tunnel syndrome.[cedars-sinai.edu]
  • The most common side effects reported are: An injection site reaction such as pain, numbness, redness, and swelling Muscle and joint pain Tingling and numbness Unusual skin sensations Headache Adults also commonly report swelling associated with fluid[saizenus.com]
  • The symptoms might include swelling in the hands and feet, pain in the large joints, and carpal tunnel syndrome.[ccpd.ucsf.edu]
  • Edema (swelling). 2. Joint pains. 3. Muscle pains. 4. Tingling, numbness, usually at the wrist. 5. Carpal tunnel syndrome. 6. Headache.[onlinemedinfo.com]
  • They include: Headaches Muscle or joint pain Mildly underactive thyroid gland Swelling of hands and feet Curvature of the spine (scoliosis) Development of breast tissue in boys Rare but serious side effects include: Severe headache with vision problems[hormone.org]
Anosmia
  • An evidently short stature for appropriate age or reduced height velocity over the course of few years and neurological deficits that may point to intracranial lesions (anosmia or visual deficits) are findings that require exclusion of GHD as the underlying[symptoma.com]
Jaundice
  • The proband is a 5-year-old girl who presented with neonatal hypoglycaemia and prolonged jaundice. No definitive endocrine cause of hypoglycaemia was identified in the neonatal period.[ncbi.nlm.nih.gov]
  • […] reduced height velocity over the course of few years and neurological deficits that may point to intracranial lesions (anosmia or visual deficits) are findings that require exclusion of GHD as the underlying cause, while neonatal signs include prolonged jaundice[symptoma.com]
  • Besides micropenis in males, additional consequences of severe deficiency in the first days of life can include hypoglycemia and exaggerated jaundice (both direct and indirect hyperbilirubinemia).[en.wikipedia.org]
  • . • Increased fat • Short stature • High pitched voice • Perinatal hx: pregnancy, perinatal events, prolonged jaundice • Micropenis, undescended testis. • Increased fat • High pitched voice • Low threshold for hypoglycemia 17.[slideshare.net]
  • Generally, the neonate with isolated GHD exhibits hypoglycemia, prolonged jaundice and microphallus and/or cryptorchidism in males [ 4 ].[intechopen.com]
Hemianopsia
  • Additional signs include increased obesity and neurological deficits that may suggest the underlying cause (bitemporal hemianopsia in the setting of a pituitary adenoma or anosmia due to a presence of a craniopharyngioma), but a thorough diagnostic evaluation[symptoma.com]
Dry Eyes
  • Furthermore, the patient developed benign cervical lymphadenopathy, as well as elevated erythrocyte sedimentation rate, positive autoantibodies to SSA-Ro, and severely dry eyes, which partially responded to both the punctate occlusion and systemic corticosteroids[ncbi.nlm.nih.gov]
Thin Skin
  • Anxiety and/or depression Baldness (in men) Decrease in sexual function and interest Decreased muscle mass and strength Difficult to concentration and lack of memory Dry, thin skin Elevated triglyceride levels Fatigue and/or tiredness Heart problems High[endocrineweb.com]
  • Symptoms of GHD in adults include: Increased fat, especially around the waist Lower muscle mass and strength Mild bone loss Thinning skin Sleep problems Decreased exercise performance Decreased energy Decreased well-being, mild depression, or moodiness[hormone.org]
Osteoporosis
  • She was for the first time diagnosed as panhypopituitarism including growth hormone deficiency and osteoporosis by endocrine examinations and bone mineral densitometry, respectively.[ncbi.nlm.nih.gov]
  • In adults, symptoms include: Decreased energy Increase in fat and decrease in lean muscle mass Difficulty exercising Osteoporosis Sleep disturbance Skin changes (fine lines, dryness, thinning) Psychological symptoms, such as depression and feelings of[ucsfhealth.org]
  • People with adult-onset growth hormone deficiency also have a higher risk of developing osteoporosis or brittle bones and, therefore, have a higher risk of developing fractures from minor injuries.[yourhormones.info]
  • Untreated, growth hormone deficiency has a two to three fold increase in premature heart disease and an increase in diabetes, high blood pressure, osteoporosis and strokes.[drmarinajohnson.com]
Arthralgia
  • A total of 55.2% of patients were reported to have experienced adverse events (AEs), including arthralgia, myalgia, abdominal distension and hypoaesthesia, and 4.5% had adverse drug reactions.[ncbi.nlm.nih.gov]
  • Of the remaining 5 patients in the GH group, 2 patients withdrew from the study because of arthralgia, 2 patients for personal reasons, and 1 patient underwent cardiac transplantation.[heartfailure.onlinejacc.org]
  • […] appropriate dosage may be monitored through regular evaluation of serum IGF-1, and IGF-1 should be in the upper half of the physiological range throughout therapy. rhGH is rather safe to use, as side effects are very rarely encountered, most common being arthralgia[symptoma.com]
  • GH REPLACEMENT THERAPY: SE Common: Edema, arthralgias, and myalgias Others: Atrial fibrillation Iatrogenic acromegaly Benign intracranial hypertension Increase in melanocytic nevi Carpal tunnel syndrome Muscle stiffness Headache Paresthesias Hyperglycemia[slideshare.net]
  • Table 3: Common adverse reaction rates Adverse reaction Occurrence (per cent) Fluid retention 37.4 Arthralgia 19.1 Muscle pains 15.7 Contraindications Absolute contraindications include evidence of any active tumour, BIH, pregnancy, and post-renal transplantation[pharmaceutical-journal.com]
Skeletal Dysplasia
  • Here, we report a novel disorder in three adult patients with a phenotype including cataracts, short-stature secondary to growth hormone deficiency, sensorineural hearing deficit, peripheral sensory neuropathy, and skeletal dysplasia.[ncbi.nlm.nih.gov]
  • . • Skeletal dysplasia • Nonnan syndrome 31. GH REPLACEMENT THERAPY • Contraindications • Active neoplasm • Retinopathy • Uncontrolled DM • Intracranial hypertension • Prader-Willi syn closed epiphyses • CRF closed epiphysis • Pregnancy 32.[slideshare.net]
  • .), other chronic conditions (psychosocial short stature, chronic renal insufficiency, liver disease, hypothyroidism, etc.) and genetic conditions that impact growth (skeletal dysplasias, familial short stature, Russell-Silver Syndrome, Turner Syndrome[magicfoundation.org]
  • The major cause of short stature in Turner syndrome and other patients with SHOX defects with or without skeletal dysplasia is haploinsufficiency of the SHOX gene.[doi.org]
Myalgia
  • A total of 55.2% of patients were reported to have experienced adverse events (AEs), including arthralgia, myalgia, abdominal distension and hypoaesthesia, and 4.5% had adverse drug reactions.[ncbi.nlm.nih.gov]
  • GH REPLACEMENT THERAPY: SE Common: Edema, arthralgias, and myalgias Others: Atrial fibrillation Iatrogenic acromegaly Benign intracranial hypertension Increase in melanocytic nevi Carpal tunnel syndrome Muscle stiffness Headache Paresthesias Hyperglycemia[slideshare.net]
  • Overall, rhGH is believed to be safe and significant side-effects in children are very rare, including benign intracranial hypertension, hyperglycaemia, arthralgia and myalgia.[intechopen.com]
  • Initiating therapy at low doses (total dose 0.2–0.4 mg/day SC) decreases the likelihood of developing common side effects like joint stiffness, arthralgias, myalgias, paresthesias, and peripheral edema, with fluid retention.[frontiersin.org]
Knee Pain
  • This may be a sign of increased pressure in the brain Any allergic reaction you experience to the injection of Nutropin therapy A limp or have hip or knee pain A fracture in the ball of the hip joint can occur in children who have endocrine problems and[nutropin.com]
  • Hip and knee pain or a limp in children, which can be a sign that the thigh bone and hip joint may have slipped out of place Curvature of the spine or backbone in children (scoliosis) Pain and tenderness in the abdomen, which could be a sign of a problem[saizenus.com]
  • Tell your or your child’s healthcare provider if you or your child has darkening of the skin, severe fatigue, dizziness, weakness or weight loss decrease in thyroid hormone levels hip and knee pain or a limp in children (slipped capital femoral epiphysis[norditropin.com]
  • Any child taking Humatrope who develops a limp or complains of hip or knee pain should be seen by a doctor to check for this. Progression of curvature of the spine (scoliosis) can occur in children who have rapid growth.[humatrope.com]
Emotional Lability
  • […] clinical syndrome includes: Altered body composition (increased fat mass, decreased lean body mass) Decreased muscle strength Altered lipid profile Decreased bone mineral density Diminished quality of life, characterized by low energy level, increased emotional[stanfordhealthcare.org]
  • Patients with GH deficiency often complain of impaired concentration, “brain fog,”poor short-term memory, forgetfulness, emotional lability, depression, apathy, social isolation, and impaired sexuality.[pituitaryworldnews.org]
  • Contributory features include reduced energy levels, emotional lability, poor sexual relationships and increased social isolation. Poor memory and concentration skills have also been demonstrated.[pharmaceutical-journal.com]
Headache
  • CASE PRESENTATION: Here, we describe a 17-year old boy referred to our hospital for fatigue, decreased muscle strength and severe headache reported after the cessation of rhGH treatment for a GH deficiency diagnosed at the age of 2 years and 3 months.[ncbi.nlm.nih.gov]
  • They include: Headaches Muscle or joint pain Mildly underactive thyroid gland Swelling of hands and feet Curvature of the spine (scoliosis) Development of breast tissue in boys Rare but serious side effects include: Severe headache with vision problems[hormone.org]
  • Common side effects include: headache, fluid retention, muscle and joint pain, and slippage of hip bones. References National Institutes of Health. Growth Hormone. . Accessed May 7, 2015.[pantherspecialty.com]
  • The most common side effects reported are: An injection site reaction such as pain, numbness, redness, and swelling Muscle and joint pain Tingling and numbness Unusual skin sensations Headache Adults also commonly report swelling associated with fluid[saizenus.com]
  • Headache. These side-effects are usually due to a large initiating dose of growth hormone and usually subsides by reducing the dose.[onlinemedinfo.com]
Sleep Disturbance
  • In adults, symptoms include: Decreased energy Increase in fat and decrease in lean muscle mass Difficulty exercising Osteoporosis Sleep disturbance Skin changes (fine lines, dryness, thinning) Psychological symptoms, such as depression and feelings of[ucsfhealth.org]
  • In adults symptoms include: decreased energy a feeling of social isolation increase in fat and decrease in lean muscle mass poor exercise tolerance osteoporosis sleep disturbance skin abnormalities (fine wrinkling, dryness, thinning) Some studies show[ccpd.ucsf.edu]
  • disturbance abnormal stage 3 & 4 (when GH is not secreting) Dysthymia Decrease in body mass Reduced IGF-1 Decrease in 24 hr GH secretion Response to GH treatment The cytokines interact with nerves that travel to the brain which signals down the spinal[worldhealth.net]
Memory Impairment
  • Finally, patients with GH deficiency appear to have impaired psychological well being and potentially significant neuropsychiatric manifestations, such as lack of concentration and memory impairment.[pituitary.mgh.harvard.edu]
  • Patients with GHD appear to have impaired psychological well-being and potentially significant neuropsychiatric manifestations, such as difficulty concentrating and memory impairment ( McGauley et al., 1990 ).[frontiersin.org]

Workup

A detailed physical examination and patient history are key initial steps in the diagnostic workup, in order to assess the present signs and symptoms that may point to GHD. Basic laboratory findings may reveal a reduced GFR, dyslipidemia and impaired glucose levels [1] [11]. Endocranial MRI is a pivotal imaging procedure, as it may point to a lesion responsible for suppressed GH production, such as a tumor or other infiltrative diseases [3]. Evaluation for other pituitary hormone deficiencies (TSH, FH, LH, ACTH) should be performed as well, since individuals that have 3 or more pituitary hormone deficiencies can be almost definitely diagnosed with GHD without the use of GH stimulation test, an invasive and time-consuming, but also dangerous procedure because of potentially severe side effects [5]. Although GH stimulation (also known as insulin tolerance test, or ITT ) is considered to be the gold standard for the diagnosis, it is contraindicated in patients who report a history of seizures or ischemic heart disease [1] [3]. Additionally, false-positive values may be obtained in morbidly obese patients. For this reason,an introduction of alternative diagnostic methods, such as GH-releasing peptide-2 (GHRP-2) test into regular practice is becoming more common, since they are safe and more convenient [1]. Measurement of IGF-1 has also been recommended in GHD patients and values below normal are highly indicative of the diagnosis, but some patients may present with IGF-1 levels within physiological limits, in which case other tests need to be used for confirmation [1].

Dyslipidemia
  • Dyslipidemia and hyperuricemia were the most common metabolic disturbances in Chinese patients.[ncbi.nlm.nih.gov]
  • Basic laboratory findings may reveal a reduced GFR, dyslipidemia and impaired glucose levels.[symptoma.com]
  • […] children with growth hormone (GH) deficiency is due almost entirely to other pituitary hormone deficiencies. [1] These children have an increased relative risk of death in adulthood from cardiovascular causes resulting from altered body composition and dyslipidemia[emedicine.medscape.com]
Cholesterol Increased
  • Increase in LDL cholesterol (bad cholesterol) and triglycerides and decrease in HDL cholesterol (good cholesterol). Increased risk for heart attack, heart failure and stroke. Decrease in bone mass with increased risk for fractures.[onlinemedinfo.com]
  • Increased triglyceride Decreased HDL-cholesterol Decrease or no change in total and LDL-cholesterol No change or decrease in total triglyceride No change or increase in HDL-cholesterol Increase or no change in lipoprotein-a Where there have been conflicting[pharmaceutical-journal.com]
  • Increased levels of fibrinogen and plasminogen activator inhibitor Cardiac dysfunction, including a thickened intima media Growth hormone deficiency in childhood commonly has no identifiable cause (idiopathic), and adult-onset GHD is commonly due to[en.wikipedia.org]

Treatment

Substitution with GH is the cornerstone of treatment in all patients, but the optimal dose depends on age, gender, percentage of adipose tissue and additional drug use, which may present a challenge for the physician [1]. Recombinant human GH (rhGH) has become available in recent years and is recommended in a treatment of various diseases that disrupt the pituitary gland and GH concentrations [6]. It must be stated that the dose should never be titrated according to body weight and all of the mentioned factors should be taken into consideration [1]. In general, a dose of approximately 0.1 mg/day in the evening should be given when initiating treatment through subcutaneous injections and a gradual increase in dosing is recommended based on the individual response and laboratory values [1]. In women who receive estrogen, a higher GH dose is required, especially if estrogen is taken orally, as it interferes with GH and hepatic IGF-1 [1]. The appropriate dosage may be monitored through regular evaluation of serum IGF-1, and IGF-1 should be in the upper half of the physiological range throughout therapy [1]. rhGH is rather safe to use, as side effects are very rarely encountered [1] [12], most common being arthralgia and edema as a result of water retention by GH [1]. Hyperglycemia, hypertension, and dyslipidemia have also been reported as adverse effects, but more importantly, a growing number of papers are investigating a potential link between increased incidence of cancer in patients who receive GH, although no solid conclusions have been made so far [6]. Because of the fact that GHD necessitates life-long therapy, certain authors suggest that a quality-of-life questionnaire should be implemented in regular practice, for the purposes of long-term monitoring and design of optimal care [7]. Because of the beneficial effects on the cardiovascular, skeletal and endocrine system, treatment with rhGH is advised even after maximal height and plateau of body growth is reached, but its cost-effectiveness has questioned this type of treatment [4] [6].

Prognosis

When compared to the general population, mortality rates of AO-GHD have shown to be higher, primarily because of cardiovascular and other complications that develop in these patients, but the exact pathophysiological mechanisms that lead to increased mortality rates are not entirely clear [1]. Inappropriate replacement of pituitary hormones other than GH may be one of the reasons, while a presence of concomitant risks and adverse events that occur may also be involved [1]. It is important to mention that almost 50% of children with this condition are left undiagnosed [4], which is why high clinical suspicion toward GHD should be present when evaluating short stature and changes in growth and body composition.

Etiology

GHD may arise as a result of genetic, but also various acquired conditions [1] [2]:

In a small number of cases, the cause remains unknown, in which case the diagnosis of idiopathic GHD is made [1].

Epidemiology

In the United Kingdom, GHD has an established incidence rate of 1 in 3,500-4,000 live births, with similar results obtained in the United States (1 in at least 3,480) [4] [9]. AO-GHD appears at an incidence rate between 1.42 and 1.9 per 100,000 individuals in Denmark, while prevalence rates in UK adults are around 1 in 3,000 [4]. Gender predilection toward males has been confirmed in several reports [9] [10].

Sex distribution
Age distribution

Pathophysiology

Under physiological conditions, GH plays an essential role in maintaining normal body composition, primarily muscle mass, and percentage of adipose tissue [1]. Decreased glucose uptake and accelerated protein synthesis are induced in muscular tissue by GH, whereas cardiovascular effects include an increase in myocardial mass, cardiac output and increase in exercise capacity [4]. Because of GH deficiency, a significant decrease in lean body mass and total body water occurs, leading to an increase in fat content [1], while a low rate of bone mineralization leads to osteopenia and reduced bone mineral density [1]. An inability of the cardiovascular system to grow at desired rate occurs and is the reason why fatigue and the quality of life in general, is affected [4]. Apart from the apparent effects of GH on body composition, its role in an induction of inflammatory parameters (including CRP and IL-6) has been documented as well [1], leading to the assumption that GH also plays an important role in functioning of the immune system.

Prevention

Unfortunately, it is not possible to prevent GHD, but an early diagnosis and identification of the underlying cause may significantly reduce the burden of the disease and provide a better quality of life.

Summary

Growth hormone deficiency (GHD) is a disorder that develops as a part of numerous conditions that involve the pituitary gland and cause insufficient production of growth hormone (GH) [1]. Genetic disorders involving GH and growth hormone-releasing hormone (GHRH) receptors, congenital abnormalities such as encephalocele, empty sella syndrome and septooptic dysplasia, endocranial tumors (adenoma, craniopharyngioma, or metastatic disease) and perinatal/postnatal trauma are some of the conditions that may interfere with production and activity of GH [1] [2]. Epidemiology studies show that the incidence rates of GHD vary between 1 in 4,000-10,000 live births and a significant predilection toward males is detected [3]. Under physiological conditions, GH is responsible for achieving adequate bone mass, lean body mass, and overall tissue growth, which is why the clinical presentation universally includes growth retardation and short stature [3]. Depending on the underlying cause, the onset of symptoms may be in childhood or in adulthood and the terms childhood-onset GHD (CO-GHD) and adult-onset GHD (AO-GHD) are frequently used in literature to distinguish the two forms [4]. Additional signs include increased obesity and neurological deficits that may suggest the underlying cause (bitemporal hemianopsia in the setting of a pituitary adenoma or anosmia due to a presence of a craniopharyngioma), but a thorough diagnostic evaluation is necessary to confirm GHD as a cause of symptoms. Dyslipidemia, impaired glucose metabolism and disturbances of other pituitary hormones, such as thyroid-stimulating hormone (TSH), adrenocorticotropic hormone (ACTH), luteinizing hormone (LH) and follicular stimulating hormone (FSH) may be detected too, as studies have shown that GH abnormalities are present in almost 100% of cases when 3 or more pituitary hormones are disturbed [5]. Magnetic resonance imaging (MRI) of the endocranium is an important imaging procedure that may identify the lesion responsible for GHD, but to confirm the diagnosis, GH stimulation test should be performed [1]. Despite being the gold standard in these patients, it requires a rigorous preparation under close supervision, which is why GH-releasing peptide-2 (GHRP-2) test and measurements of insulin-growth factor 1 (IGF-1) are often done instead because they are safe and more easily performed [1] [3]. The mainstay of treatment is supplementation with recombinant human GH (rhGH) in a carefully designed regimen and life-long therapy may be recommended due to a prevention of adverse effects that may occur later in life (osteopenia, dyslipidemia, and other metabolic changes). The issue of cost-effectiveness, however, has emerged as an issue in clinical practice [6]. GHD has shown to affect the quality of life of many patients [7], making long-term care and evaluation mandatory in ensuring good patient outcomes.

Patient Information

Maintenance of proper body composition and adequate growth are the main functions of growth hormone (GH), which is synthesized in the hypophysis (also known as the pituitary gland) and numerous conditions may impair its activity in the body or its production. Growth hormone deficiency (GHD) is a clinical entity that is defined as markedly reduced activity of GH in the body, leading to growth retardation and symptoms such as accumulation of fat and reduction in muscle mass. Other findings include a reduced bone mass that may be a risk for fractures, as well as various neurological symptoms, depending on the underlying cause. Brain tumors, genetic diseases that affect GH receptors, trauma experienced in pregnancy or during delivery and various congenital defects may all be responsible for an insufficient synthesis of GH. It is estimated that 1 in 4,000-10,000 individuals develops GHD due to any cause and a significant predilection toward males is established. To make an initial diagnosis, it is essential to perform a thorough workup consisting of laboratory studies that may reveal changes in lipid levels, altered glucose concentrations and derangement of other pituitary hormones, together with imaging studies of the brain in the form of magnetic resonance imaging (MRI), which may point to the underlying cause. To confirm GHD, however, GH-stimulation test is considered to be the most reliable diagnostic method and consists of serial blood sampling in a matter of several hours after use of various drugs. But because it is contraindicated in patients suffering from seizures and heart disease and the fact that it may cause serious adverse effects, alternative and safer methods of evaluation are more frequently performed, including measurement of insulin-growth factor 1 (IGF-1) and GH-releasing peptide-2 (GHRP-2) test. Treatment principles rely on supplementation with recombinant human GH (rhGH) and the regimen depends on the patient's age, gender, a presence of comorbidities and current drug use. The beneficial effects of prolonged rhGH supplementation on the musculoskeletal and cardiovascular system have been brought into question by a very large cost of treatment, while certain studies are pointing to an increased risk of malignancy when using GH as a therapeutic measure. Because GHD may severely impact the overall quality of life of the patient, long-term monitoring, and care are necessary to provide optimal therapy.

References

Article

  1. Fukuda I, Hizuka N, Muraoka T, Ichihara A. Adult Growth Hormone Deficiency: Current Concepts. Neurol Med Chir (Tokyo). 2014;54(8):599-605.
  2. Bierich JR. Aetiology and pathogenesis of growth hormone deficiency. Baillieres Clin Endocrinol Metab. 1992;6(3):491-511.
  3. Stanley T. Diagnosis of Growth Hormone Deficiency in Childhood. Current Opinion in Endocrinology, Diabetes, and Obesity. 2012;19(1):47-52.
  4. Ahmid M, Perry CG, Ahmed SF, Shaikh MG. Growth hormone deficiency during young adulthood and the benefits of growth hormone replacement. Endocr Connect. 2016;5(3):R1-R11.
  5. Hartman ML, Crowe BJ, Biller BM, et al. Which patients do not require a GH stimulation test for the diagnosis of adult GH deficiency?. J Clin Endocrinol Metab. 2002;87(2):477-485.
  6. Hazem A, Elamin MB, Bancos I, et al. Body composition and quality of life in adults treated with GH therapy: a systematic review and meta-analysis. Eur J Endocrinol. 2012;166(1):13-20.
  7. Rosilio M, Blum WF, Edwards DJ, et al. Long-term improvement of quality of life during growth hormone (GH) replacement therapy in adults with GH deficiency, as measured by questions on life satisfaction-hypopituitarism (QLS-H). J Clin Endocrinol Metab. 2004;89 (4):1684-1693.
  8. Rainbow LA, Rees SA, Shaikh MG. Mutation analysis of POUF-1, PROP-1 and HESX-1 show low frequency of mutations in children with sporadic forms of combined pituitary hormone deficiency and septo-optic dysplasia. Clin Endocrinol (Oxf). 2005;62(2):163-168.
  9. Lindsay R, Feldkamp M, Harris D, Robertson J, Rallison M. Utah Growth Study: Growth standards and the prevalence of growth hormone deficiency. The Journal of Pediatrics. 1994;125(1):29-35.
  10. Stochholm K, Gravholt CH, Laursen T, Jorgensen JO, Laurberg P, Andersen M. Incidence of GH deficiency - a nationwide study. Eur J Endocrinol. 2006;155(1):61-71.
  11. Cuneo RC, Salomon F, McGauley GA, Sönksen PH. The growth hormone deficiency syndrome in adults. Clin Endocrinol (Oxf). 1992;37(5):387-397.
  12. Blethen SL, Allen DB, Graves D. Safety of recombinant deoxyribonucleic acid-derived growth hormone: The National Cooperative Growth Study experience. J Clin Endocrinol Metab. 1996;81(5):1704-1710.

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Last updated: 2019-07-11 20:32