The diagnosis and treatment of growth hormone deficiency in adults.
OBJECTIVE
This review summarizes the recent published information regarding efficacy and complications of growth hormone replacement therapy. Several recent reports have monitored patients for periods of up to 10 years. Additionally, a consensus conference has been held regarding needed improvements in diagnostic testing and the recommendations of consensus panels regarding diagnostic criteria and laboratory test utilization are summarized.


RESULTS
Long-term studies show growth hormone can be administered safely and that muscle strength and function as well as lipoprotein abnormalities and low-bone mineral density show sustained improvement over extended periods of time. The complications that occur are generally dose-dependent and once attenuated do not tend to recur. Long-term safety studies regarding improvement in cardiovascular mortality and/or worsening prognosis for patients who develop malignancies are available only in the form of observational studies and randomized controlled long-term trial information is not yet available. The studies reported provide a means for clinicians to ascertain the patients who are likely to derive the greatest benefit from growth hormone when the appropriate diagnostic testing and treatment paradigms are utilized.


CONCLUSIONS
The studies that are summarized provide useful information for assessing the response to treatment, selecting patients who are candidates for long-term replacement therapy and for selecting those in whom the need for therapy may need to be reassessed.
Clemmons
David R
DR
Division of Endocrinology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7170, USA. endo@med.unc.edu
D000328:Adult; D001823:Body Composition / Q000187:drug effects / Q000502:physiology; D050260:Carbohydrate Metabolism / Q000187:drug effects / Q000502:physiology; D002319:Cardiovascular System / Q000187:drug effects / Q000503:physiopathology; D003940:Diagnostic Techniques, Endocrine; D006130:Growth Disorders / Q000175:diagnosis* / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D020249:Hormone Replacement Therapy / Q000009:adverse effects / Q000379:methods; D019382:Human Growth Hormone / Q000009:adverse effects / Q000172:deficiency* / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D050356:Lipid Metabolism / Q000187:drug effects / Q000502:physiology; D011506:Proteins / Q000378:metabolism
D011506:Proteins; D019382:Human Growth Hormone