title: Guidelines for optimizing growth hormone replacement therapy in adults.
abstract: To minimize the rate of side-effects, a retrospective analysis of 28 studies of GH replacement therapy in adults indicates that the maintenance dose should usually not exceed 1.0 IU/m2/day (about 1.5-2.0 IU/day) in GHD patients 40-60 years old, or 1.5 IU/m2/day (about 2.5-3.0 IU/day) in GHD patients 20-40 years old. GHD women may tolerate, and in fact may need, higher replacement doses, though this issue requires further investigation. GH treatment should be started at a low dose, i.e. about 1.0 IU/day, and increased gradually, by about 0.5 IU per month, until the target dose is reached. In the absence of side-effects, the GH dose may be either too low, adequate, or too high. Measurement of GH-dependent serum markers provides the most promising approach to detect both GH depletion and excess, with serum IGF-I concentration the current method of choice. Clinical awareness of symptoms of GH excess remains important, however, particularly in patients with IGF-I levels in the high normal range.
authors.affiliation: Department of Endocrinology, Free University Hospital Amsterdam, The Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: de Boer
authors.forename: E
authors.initials: E
authors.lastname: van der Veen
mesh_terms: D000328:Adult; D005260:Female; D013006:Growth Hormone / Q000008:administration & dosage* / Q000097:blood / Q000172:deficiency* / Q000627:therapeutic use*; D006801:Humans; D008297:Male
chemical_list: D013006:Growth Hormone