GH replacement in adults: interactions with other pituitary hormone deficiencies and replacement therapies.
Severe GH deficiency (GHD) in adults has been described as a clinical entity. However, some of the features associated with GHD could be due to unphysiological and inadequate replacement of other pituitary hormone deficiencies. This may be true for glucocorticoid replacement that lacks a biomarker making dose titration and monitoring difficult. Moreover, oral estrogen replacement therapy decreases IGF1 levels compared with the transdermal route, which attenuates the responsiveness to GH replacement therapy in women. In addition, in untreated female hypogonadism, oral estrogen may augment the features associated with GHD in adult women. Important interactions between the hormones used for replacing pituitary hormone deficiency occur. Introducing GH replacement may unmask both an incipient adrenal insufficiency and central hypothyroidism. Therefore, awareness and proper monitoring of these hormonal interactions are important in order to reach an optimal replacement therapy. This review will focus on the complex hormonal interactions between GH and other pituitary hormones in GHD and in GH replacement.
Filipsson
Helena
H
Department of Endocrinology, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg University, Sweden.
Johannsson
Gudmundur
G
D000279:Administration, Cutaneous; D000284:Administration, Oral; D000309:Adrenal Insufficiency / Q000175:diagnosis; D000328:Adult; D015415:Biomarkers / Q000097:blood; D015914:Estrogen Replacement Therapy; D004967:Estrogens / Q000008:administration & dosage; D005260:Female; D005938:Glucocorticoids / Q000097:blood; D019382:Human Growth Hormone / Q000172:deficiency* / Q000627:therapeutic use*; D006801:Humans; D007018:Hypopituitarism / Q000188:drug therapy; D007037:Hypothyroidism / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D010907:Pituitary Hormones / Q000172:deficiency* / Q000627:therapeutic use*; D012720:Severity of Illness Index; D012737:Sex Factors; D013974:Thyroxine / Q000097:blood
D015415:Biomarkers; D004967:Estrogens; D005938:Glucocorticoids; D010907:Pituitary Hormones; D019382:Human Growth Hormone; D013974:Thyroxine