Adult-onset growth hormone deficiency: causes, complications and treatment options.
OBJECTIVE
Description of the progresses related to the complications and treatment of adult-onset growth hormone deficiency.


RESULTS
Growth hormone deficiency in adults has gained attention as a clinical syndrome associated with increased morbidity and possibly mortality. Many studies have been conducted on the consequences of growth hormone deficiency and of its replacement, supporting its use in appropriate patients. Early studies were characterized by a high incidence of side effects due to a lack of pilot data to guide appropriate dosing. Given the wide variability in individual responsiveness to growth hormone therapy based on age, sex, and body composition, recent work has been dedicated to understanding which patients derive benefit from therapy, minimizing side effects, and ensuring cost-effectiveness.


CONCLUSIONS
Long-term prospective trials have shown that growth hormone replacement therapy results in improvements in body composition, dyslipidemia, bone mineral density, and quality of life. The effects on endpoints such as cardiovascular morbidity and mortality and fractures are, however, not fully proven. Randomized trials that compare homogenous groups of growth hormone deficiency patients are still needed. Given the high cost of treatment, dynamic testing for growth hormone deficiency should only be performed in patients in whom there is high clinical suspicion, and therapy should be limited to those with biochemically proven growth hormone deficiency.
Mathioudakis
Nestoras
N
Division of Endocrinology and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287. USA.
Salvatori
Roberto
R
D000328:Adult; D050197:Atherosclerosis / Q000209:etiology / Q000378:metabolism; D001823:Body Composition; D015519:Bone Density; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality; D003677:Deficiency Diseases / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D006130:Growth Disorders / Q000150:complications / Q000188:drug therapy* / Q000209:etiology; D020249:Hormone Replacement Therapy; D019382:Human Growth Hormone / Q000008:administration & dosage / Q000172:deficiency*; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000378:metabolism; D007333:Insulin Resistance; D011788:Quality of Life
D019382:Human Growth Hormone