The management of adult growth hormone deficiency syndrome

In patients with hypopituitarism, growth hormone deficiency (GHD) is almost inevitably present. Lack of other pituitary hormones may require prompt replacement, but lack of growth hormone (GH) is also associated with several abnormalities. Growth hormone treatment safely improves or normalizes many of these deviations.

The aberrations include low bone mass and increased risk of fractures, abnormal body composition in terms of increased fat mass, and reduced lean body mass resulting in reduced muscle mass and strength. The decreased exercise capacity in GHD may be influenced by impaired cardiac performance and heat intolerance. Increased abdominal fat results in metabolic disturbancies such as reduced insulin sensitivity and hyperlipidemia, leading to an increased risk of cardiovascular diseases. Patients with hypopituitarism who have had relevant hormones replaced except GH have increased mortality due to, for example, cardiovascular diseases.

Thus, it is important to diagnose GHD, which requires precise diagnostic criteria and methods. Dynamic testing of GH secretion with insulin tolerance test or arginine + GH releasing hormone can be used. Patients with childhood onset GHD should be re-evaluated if GH therapy is maintained into adulthood. Although GH replacement therapy improves the patophysiological manifestations of GHD and quality of life, it is unclear whether mortality is reduced.