Adult growth hormone deficiency (GHD): an established diagnosis?

The adult GH deficiency (GHD) indication is now an established clinical therapy worldwide. However, as the number of patients being replaced with GH increases, some aspects in the management of adult GHD patients emerge which are not yet fully defined. These aspects relate primarily to the diagnosis of adult GHD which had initially been based on criteria developed for patients with typical forms of adult pituitary disease (pituitary tumor); the expanding spectrum of the adult GHD indication has disclosed the full variability of the clinical presentation of the adult GHD syndrome indicating the limitations of some existing diagnostic criteria. Other aspects affected by the expanding spectrum of the adult GHD diagnosis are the separation of adult from childhood onset patients and the assessment of long-term outcomes after GH replacement. However, such a situation is by no means surprising as also the use of GH in pediatric endocrinology has been currently improved over decades, based on accumulating clinical experience. Thus it can be anticipated that the adult GHD indication will follow a similar pattern, and more and more optimisation steps will be introduced over time as experience with GH treatment in adults accumulates.