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Growth hormone deficiency in Cushing's syndrome: an update on diagnosis and management

Nicholas A Tritos1,2

  • 1Neuroendocrine Unit and Neuroendocrine and Pituitary Tumor Clinical Center, Massachusetts General Hospital, Boston, Massachusetts, USA.

Expert Review of Endocrinology & Metabolism
|September 13, 2025
PubMed

Insights

Growth hormone deficiency (GHD) is common in patients with Cushing's syndrome (CS) in remission. Growth hormone replacement therapy can improve outcomes in children and adults, but requires careful monitoring.

Area of Science:

  • Endocrinology
  • Metabolic Disorders

Background:

  • Endogenous Cushing's syndrome (CS) leads to significant health issues and mortality.
  • Growth hormone deficiency (GHD) is a frequent comorbidity in patients with CS, persisting even after remission.

Purpose of the Study:

  • To review the epidemiology, mechanisms, and clinical aspects of GHD in patients with CS in remission.
  • To discuss GHD diagnosis and the efficacy and safety of growth hormone replacement therapy.

Main Methods:

  • Systematic electronic literature search (PubMed) up to July 2025.
  • Review focused on patients with Cushing's disease (pituitary CS).

Main Results:

  • GHD is prevalent in active CS and can persist in remission.
  • In children, GHD causes decreased linear growth. In adults, GHD is linked to increased cardiometabolic burden, reduced muscle strength, lower bone density, and higher fracture rates.
  • Growth hormone replacement in children improves adult height; in adults, it may enhance quality of life, bone density, muscle strength, and lipid profiles, with a risk of hyperglycemia.

Conclusions:

  • GHD is a significant concern for patients with CS in remission.
  • Growth hormone replacement is beneficial for both pediatric and adult patients in remission, necessitating careful monitoring for potential side effects like hyperglycemia.
Abstract

Keywords:
Cushing’s diseasecushing’s syndromegrowth hormone deficiencygrowth hormone stimulation testinsulin-like growth factor I

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