Optimizing gh therapy in adults and children.

Area of Science:

• Endocrinology
• Pediatric Endocrinology
• Metabolic Disorders

Background:

• Growth hormone (GH) deficiency diagnosis in adults historically lacked clinical significance beyond indicating hypothalamo-pituitary disease.
• Modern imaging and recombinant human GH (rhGH) have highlighted a distinct clinical syndrome and the potential for rhGH therapy.
• Assessing GH status in adults is challenging due to diverse GH actions and concerns about cancer risk influenced by insulin-like growth factor-I (IGF-I).

Purpose of the Study:

• To examine the physiological role of GH in adults after linear growth cessation.
• To establish safe and effective methods for judging overall GH status and optimizing GH replacement therapy in adults.
• To evaluate current practices and identify areas for improvement in GH replacement protocols, particularly the transition from pediatric to adult care.

Main Methods:

• Review of clinical practice and existing literature on GH deficiency and replacement therapy.
• Clinical assessment of patient response to GH replacement.
• Measurement of serum IGF-I levels to guide and monitor therapy.

Main Results:

• GH replacement therapy can reverse many features of GH deficiency syndrome in adults.
• Optimal GH replacement dosing is best determined by a combination of clinical response and IGF-I levels, avoiding supraphysiological IGF-I.
• Current pediatric dosing regimens based solely on linear growth may be inappropriate for adult GH management.

Conclusions:

• GH replacement therapy is a crucial component of managing adult GH deficiency.
• Monitoring IGF-I and clinical response is essential for safe and effective GH replacement in adults.
• Further research is needed to define optimal GH replacement strategies during the transition from pediatric to adult care and to fully elucidate GH benefits in mature adults.