Advances in the Understanding of Adult Growth Hormone Deficiency Syndrome – Diagnosis, Epidemiology and Management

2010 ◽  
Vol 6 (2) ◽  
pp. 45
Author(s):  
Torben Laursen ◽  
Keyword(s):  
Growth Hormone ◽  
Cardiovascular Diseases ◽  
Dynamic Testing ◽  
Gh Deficiency ◽  
Tolerance Test ◽  
Deficiency Syndrome ◽  
Hormone Deficiency ◽  
Gh Treatment ◽  
Adult Growth ◽  
Increased Risk

In patients with hypopituitarism, growth hormone (GH) deficiency is almost always present. Lack of other pituitary hormones may require prompt replacement, but lack of GH is also associated with several abnormalities, which can be improved by GH treatment. The aberrations include low bone mass and increased risk of fractures, abnormal body composition, e.g. increased fat mass and reduced lean body mass resulting in reduced muscle mass and strength. Decreased exercise capacity may be influenced by impaired cardiac performance and heat intolerance. Increased abdominal fat results in metabolic disturbancies, such as reduced insulin sensitivity and hyperlipidaemia, increasing the risk of cardiovascular diseases. Patients with hypopituitarism replaced with relevant hormones except GH have increased mortality due to cardiovascular diseases and increased morbidity. Thus, it is important to diagnose GH deficiency, which requires precise diagnostic criteria and methods. Dynamic testing of GH secretion with an insulin tolerance test or arginine plus GH-releasing hormone can be used.

scholarly journals Malignancy risk in adults with growth hormone deficiency undergoing long-term treatment with biosimilar somatropin (Omnitrope®): data from the PATRO Adults study

2020 ◽  
Vol 11 ◽  
pp. 204201882094337
Author(s):  
Paolo Beck-Peccoz ◽  
Charlotte Höybye ◽  
Robert D Murray ◽  
Suat Simsek ◽  
Markus Zabransky ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Gh Deficiency ◽  
Real Life ◽  
Hormone Deficiency ◽  
System Organ Class ◽  
Pituitary Hormone ◽  
Gh Treatment ◽  
Post Marketing Surveillance ◽  
Increased Risk ◽  
Long Term Treatment

Background: To assess the safety (particularly the occurrence of malignancies) of growth hormone (GH) replacement (Omnitrope®) in adults with GH deficiency, using data from the ongoing PATRO Adults post-marketing surveillance study. Methods: PATRO Adults is being conducted in hospitals and specialized endocrinology clinics across Europe. All enrolled patients who receive ⩾1 dose of Omnitrope® are included in the safety population. Malignancies are listed as adverse events under the MedDRA System Organ Class ‘neoplasms, benign, malignant and unspecified (including cysts and polyps)’. Results: As of July 2018, 1293 patients had been enrolled in the study and 983 (76.0%) remained active in the study. Approximately half [ n = 637 (49.3%)] of the patients were GH treatment-naïve on study entry. The majority of enrolled patients had multiple pituitary hormone deficiency ( n = 1128, 87.2%). A total of 41 on-study malignancies were reported in 33 patients (2.6%; incidence rate 7.94 per 1000 patient-years). The most common cancers were basal cell carcinoma ( n = 13), prostate ( n = 6), breast, kidney and malignant melanoma (each n = 3). Treatment with Omnitrope® was discontinued following diagnosis of malignancy in 16 patients. The tumors occurred after a mean of 79.4 months of recombinant hormone GH (rhGH) treatment overall. Conclusion: Based on this snapshot of data from PATRO Adults, Omnitrope® treatment is tolerated in adult patients with GH deficiency in a real-life clinical practice setting. Our results do not generally support a carcinogenic effect of rhGH in adults with GH deficiency, although an increased risk of second new malignancies in patients with previous cancer cannot be excluded based on the current dataset.

Issues in the Transition From Childhood to Adult Growth Hormone Therapy

PEDIATRICS ◽  
1999 ◽  
Vol 104 (Supplement_5) ◽  
pp. 1004-1010
Author(s):  
David B. Allen
Keyword(s):  
Growth Hormone ◽  
Replacement Therapy ◽  
Blood Lipid ◽  
Hormone Deficiency ◽  
Late Adolescent ◽  
Gh Therapy ◽  
Gh Treatment ◽  
Beneficial Effects ◽  
Gh Replacement ◽  
Adult Growth

The consequences of severe growth hormone deficiency (GHD) in adults and the beneficial effects of GH replacement therapy are clear. However, the majority of children who have a diagnosis of GHD and who are treated with GH do not have permanent GHD and will not require treatment during adulthood. Several issues must be considered in selecting candidates for adult GH treatment and transitioning their care from pediatrics to adult medicine. Counseling about possible lifelong treatment should focus on children with panhypopituitarism and those with severe isolated GHD that is associated with central nervous system abnormalities. When to terminate growth-promoting GH therapy should be guided by balancing the high cost of late-adolescent treatment with the attainment of reasonable statural goals. Retesting for GH secretion is appropriate for all candidates for adult GH therapy; the GH axis can be tested within weeks after the cessation of treatment, but confirming an emerging adult GHD state with body composition, blood lipid, and quality-of-life assessments may require 1 year or more of observation. Selecting patients for lifelong adult GH replacement therapy will present diagnostic, therapeutic, and ethical problems similar to those in treating childhood GHD. The experience and expertise of pediatric endocrinologists in diagnosing and treating GHD should be offered and used in identifying and transitioning appropriate patients to adult GH therapy.

Glucagon Stimulation Testing in Adult Growth Hormone Deficiency— A 2014 Update

2014 ◽  
Vol 10 (01) ◽  
pp. 75
Author(s):  
Kevin C J Yuen ◽  
Keyword(s):  
Growth Hormone ◽  
Growth Hormone Deficiency ◽  
The Elderly ◽  
Tolerance Test ◽  
Clinical Findings ◽  
Clinical Syndrome ◽  
Stimulation Test ◽  
Hormone Deficiency ◽  
Insulin Tolerance ◽  
Adult Growth

Growth hormone deficiency (GHD) is a well-recognized clinical syndrome in adults, and its diagnosis is established through one or more GH stimulation tests. The decision to perform GH stimulation testing should be based on medical history and clinical findings, and using appropriate GH stimulation test/s for biochemical confirmation. The insulin tolerance test (ITT) remains the diagnostic test of choice; however, this test is labor intensive, contraindicated in the elderly and in adults with seizure disorders and ischemic heart disease, can be unpleasant for the patient, and is potentially hazardous. With the discontinuation of the growth hormone releasing hormone (GHRH) analog (Geref®) in the US in 2008, the glucagon stimulation test (GST) has gained increasing popularity as the alternative test to the ITT because of its availability, reproducibility, safety, lack of influence by gender and hypothalamic cause of GH deficiency (GHD), and relatively few contraindications. In this article, recommendations for performing this test, the potential drawbacks in conducting and caveats in interpreting this test, and its future perspectives are discussed.

scholarly journals Diagnosis and Treatment of Adult Growth Hormone Deficiency

2021 ◽  
Vol 96 (5) ◽  
pp. 400-407
Author(s):  
Jung Hee Kim
Keyword(s):  
Quality Of Life ◽  
Growth Hormone ◽  
Replacement Therapy ◽  
Gh Deficiency ◽  
Hormone Deficiency ◽  
Skeletal Health ◽  
Gh Replacement ◽  
Adult Growth ◽  
Impaired Quality

Adult growth hormone (GH) deficiency is associated with insulin resistance, elevated cardiovascular risk profile, increased fat mass, reduced muscle mass, skeletal fragility, and impaired quality of life. GH replacement therapy improves body composition, exercise capacity, skeletal health, cardiovascular outcomes, and quality of life, while reducing mortality. Prior to initiation of GH replacement therapy, it is essential to diagnose GH deficiency via a GH stimulation test in adults suspicious of such deficiency. Therapy should be started using (individualized) low dose of GH, followed by titration to the normal range of insulin-like growth factor-1. Clinical improvements should be monitored and side effects should be minimized.

scholarly journals Priobretennaya nedostatochnost' gormona rosta u vzroslykh: etiologiya, klinicheskie proyavleniya, diagnostika i vozmozhnosti lecheniya

2011 ◽  
Vol 8 (2) ◽  
pp. 11-17
Author(s):  
Vladimir Vladimirovich Vaks ◽  
Olga Aleksandrovna Gerasimenko ◽  
Larisa Konstantinovna Dzeranova
Keyword(s):  
Growth Hormone ◽  
Medical Condition ◽  
Hormone Replacement ◽  
Clinical Endocrinology ◽  
Tolerance Test ◽  
Hormone Deficiency ◽  
Dose Titration ◽  
Adult Onset ◽  
Gh Treatment ◽  
The Impact

Adult-onset growth hormone deficiency (GHD) remains one of the issues in clinical endocrinology. In this article, which is addressed to practitioners, physiology of growth hormone in adults is reviewed along with etiology and diagnostic criteria of this medical condition. In general, a stimulation test is required to recognize GHD. Insulin tolerance test (ITT) has been considered the gold standard by the most important scientific societies, although alternative tests, in particular GHRH plus arginine have been proposed as valuable alternative to ITT. The results of different clinical studies regarding the impact of adult-onset GH-deficiency on metabolism and quality of life are summarized and beneficial effects of growth hormone replacement therapy on many of the manifestations of GHD reviewed. The management of GHD in adults is discussed including initiation of GH treatment, dose titration and assessment of response during trail period.

scholarly journals Diagnosis of growth hormone deficiency in adults by testing with GHRP-6 alone or in combination with GHRH: comparison with the insulin tolerance test

2002 ◽  
pp. 667-672 ◽  
Author(s):  
S Petersenn ◽  
R Jung ◽  
FU Beil
Keyword(s):  
Growth Hormone ◽  
Gh Deficiency ◽  
Group Versus ◽  
Tolerance Test ◽  
Insulin Tolerance Test ◽  
Hormone Deficiency ◽  
Peak Response ◽  
Gh Secretion ◽  
Insulin Tolerance ◽  
Ghrh Test

OBJECTIVE: The diagnosis of GH deficiency in adults should be made using provocative testing of GH secretion. The insulin tolerance test (ITT) is recommended as the gold standard investigation. Because of the risk of serious complications, patients with epilepsy or known ischemic heart disease should not undergo this test. GHRP-6 is a synthetic hexapeptide that releases GH by binding to specific hypothalamic and pituitary receptors. We assessed the diagnostic capability of GH stimulation by GHRP-6 alone or in combination with GHRH in comparison to the results of an ITT. DESIGN: Twenty patients underwent an ITT for suspected pituitary or adrenal disease. Either GHRP-6 (1 microg/kg) alone, or GHRP-6 in combination with GHRH (1 microg/kg) were administered on different days. Blood samples were obtained during a subsequent 90-min period for measurement of GH. RESULTS: Ten patients had a GH peak response of less than 3 microg/l during ITT and were considered growth hormone deficient (GHD). The GH mean peak (+/-S.E.M., range) in this group was 0.7 microg/l (+/-0.3, 0.1-2.9) compared with 14.5 microg/l (+/-3.5, 3.8-40.8) in the group of patients with a GH peak response of more than 3 microg/l (growth hormone sufficient (GS)). For the GHRP-6 test, the GH mean peak was 1.3 microg/l (+/-0.6, 0.1-6.7) in the GHD group versus 25.7 microg/l (+/-5.5, 7.7-54.2) in the GS group. After GHRP-6+GHRH, the GH mean peaks were 4.0 microg/l (+/-1.3, 0.2-11.9) versus 54.7 microg/l (+/-11.1, 13.9-136.0) respectively. During administration of GHRP-6, the only side effects observed were flush symptoms. CONCLUSIONS: Peak GH levels below 7 microg/l for the GHRP-6 test and below 13 microg/l for the combined GHRP-6+GHRH test identified all patients with GH deficiency correctly as defined by ITT. The results suggest that testing with GHRP-6 or GHRP-6+GHRH is as sensitive and specific as an ITT for the diagnosis of adult GH deficiency.

scholarly journals Impact of the underlying etiology of growth hormone deficiency on serum IGF-I SDS levels during GH treatment in children

2017 ◽  
Vol 177 (3) ◽  
pp. 267-276 ◽  
Author(s):  
Juliane Léger ◽  
Damir Mohamed ◽  
Sophie Dos Santos ◽  
Myriam Ben Azoun ◽  
Delphine Zénaty ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Gh Deficiency ◽  
Care Center ◽  
Treatment Compliance ◽  
Hormone Deficiency ◽  
Pediatric Care ◽  
Pituitary Hormone ◽  
Gh Treatment ◽  
Pubertal Stage ◽  
Igf I

ContextRegular monitoring of serum IGF-I levels during growth hormone (GH) therapy has been recommended, for assessing treatment compliance and safety.ObjectiveTo investigate serum IGF-I SDS levels during GH treatment in children with GH deficiency, and to identify potential determinants of these levels.Design, patients and methodsThis observational cohort study included all patients (n = 308) with childhood-onset non-acquired or acquired GH deficiency (GHD) included in the database of a single academic pediatric care center over a period of 10 years for whom at least one serum IGF-I SDS determination during GH treatment was available. These determinations had to have been carried out centrally, with the same immunoradiometric assay. Serum IGF-I SDS levels were determined as a function of sex, age and pubertal stage, according to our published normative data.ResultsOver a median of 4.0 (2–5.8) years of GH treatment per patient, 995 serum IGF-I SDS determinations were recorded. In addition to BMI SDS, height SDS and GH dose (P < 0.01), etiological group (P < 0.01) had a significant effect on serum IGF-I SDS levels, with patients suffering from acquired GHD having higher serum IGF-I SDS levels than those with non-acquired GHD, whereas sex, age, pubertal stage, treatment duration, hormonal status (isolated GHD (IGHD) vs multiple pituitary hormone deficiency (MPHD)) and initial severity of GHD, had no effect.ConclusionsThese original findings have important clinical implications for long-term management and highlight the need for careful and appropriate monitoring of serum IGF-I SDS and GH dose, particularly in patients with acquired GHD, to prevent the unnecessary impact of potential comorbid conditions.

scholarly journals Skin morphological changes in growth hormone deficiency and acromegaly

2001 ◽  
pp. 147-153 ◽  
Author(s):  
M Lange ◽  
J Thulesen ◽  
U Feldt-Rasmussen ◽  
NE Skakkebaek ◽  
N Vahl ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Growth Hormone Deficiency ◽  
Morphological Changes ◽  
Hormone Deficiency ◽  
Sweat Glands ◽  
Gh Treatment ◽  
Sweat Secretion ◽  
Increased Risk ◽  
Significant Difference ◽  
Eccrine Sweat

OBJECTIVE: To evaluate the histomorphology of skin and its appendages, especially eccrine sweat glands, in patients with GH disorders, because reduced sweating ability in patients with growth hormone deficiency (GHD) is associated with increased risk of hyperthermia under stressed conditions. DESIGN AND METHODS: A skin biopsy was obtained from 17 patients with GHD treated with GH, five patients with untreated GHD, 10 patients with active acromegaly and 13 healthy controls. RESULTS: The sweat secretion rate (SSR) was significantly decreased in both the untreated (median 41 mg/30 min, range 9-79 mg/30 min) and the GH-treated (median 98 mg/30 min, range 28-147 mg/30 min) patients with GHD compared with that in controls (median 119 mg/30 min, range 90-189 mg/30 min; P=0.001 and 0.01 respectively). Epidermal thickness was significantly decreased in both untreated (median 39 microm, range 28-55 microm) and GH-treated patients with GHD (median 53 microm, range 37-100 microm), compared with that in controls (median 66 microm, range 40-111 microm; P<0.02). A statistically non-significant tendency towards thinner epidermis (median 59 microm, range 33-83 microm) was recorded in acromegalic patients (P=0.08) compared with controls. There was no significant difference in the area of the sebaceous glands in the biopsies between the three groups and the controls. The area of eccrine sweat gland glomeruli was significantly decreased in the untreated patients with GHD (median 16407 microm2, range 12758-43976 microm2) compared with that in controls (median 29446 microm2, range 13511-128661 microm2; P=0.03), but there was no significant difference between the GH-treated patients with GHD and controls. CONCLUSIONS: We conclude that GH, either directly or via IGF-I, may have both a structural and a functional effect on human skin and its appendages, and that patients with GHD have histomorphological changes in skin compared with controls. Importantly, these changes are not fully reversed despite long-term and adequate GH treatment in patients with childhood onset GHD.

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