ReviewDiagnosis of adult GH deficiency
Introduction
Adults with growth hormone deficiency (GHD) have impaired health, which improves with GH replacement. GHD in adults leads to impairment in body composition and function, as well as to deranged lipoprotein and carbohydrate metabolism and increased cardiovascular morbidity [1], [23], [28], [29], [30]. Based on evidence that GHD in adults is a new syndrome which may benefit from GH replacement, health authorities in many countries have approved the therapeutic use of GH in hypopituitaric patients with severe GHD [55], [85].
To ensure that patients are appropriately identified and treated, the Growth Hormone Research Society (GRS) convened a workshop on 1997, in Port Stephens, Australia, to formulate consensus guidelines for the diagnosis and treatment of adults with GH deficiency. The GRS invited scientists with appropriate expertise, representatives from industry involved in the manufacture of recombinant human GH, and representatives from health authorities from a number of countries to attend the workshop, all of whom contributed to these guidelines [55].
During the last decade, there is evidence indicating that the guidelines for the clinical management of adult GHD should be amended and this prompted the Growth Hormone Research Society (GRS) to convene a second workshop in Sydney, Australia, in March, 2007.
Section snippets
Diagnosis of adults GHD: current guidelines
We report the most important statements of the 1997 GRS Consensus about the diagnosis of adult GHD (in italics). Appropriate amendments (in bold) are stated.
Who should be tested: expanding the concept of appropriate clinical context to brain injury
In adulthood, hypopituitarism and GH deficiency (GHD) are more often “acquired” as consequences of hypothalamic-pituitary disease [35], [55], [85] or represent the persistence of a congenital or acquired pituitary defect diagnosed in childhood [27], [95]. Multiple pituitary deficits are often present, but isolated pituitary deficits are not uncommon. Among them, GH is usually the first of the anterior pituitary hormones to be affected [55], [85]. Thus, GHD can be considered to indicate possible
Conclusions
Ten years after, the GRS Consensus Statement requires some amendment.
From the diagnostic point of view, it is suggested that the new guidelines express:
- (a)
The concept of appropriate clinical context indicating the suspicion of adult GHD (i.e. patients with hypothalamic or pituitary disease or cranial irradiation as well as those with childhood-onset GHD) is extended to include brain injured patients.
- (b)
It is accepted that very low IGF-I levels in patients highly suspected for GHD (i.e. patients with
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Adherence to growth hormone therapy guidelines in a real-world French cohort of adult patients with growth hormone deficiency
2021, Annales d'EndocrinologieCitation Excerpt :One explanation could be physician's reluctance regarding the risk of adverse events. In the literature, IGF-1 levels have been shown to be normal in a significant proportion of adult GH deficient patients, [14] and it has been suggested to maintain IGF-1 in the upper range of normal values (between 0 and +2 DS) to adequately correct GH deficiency [15]. Unfortunately, patients were not stratified according to IGF-1 DS and we don’t know the proportion of patients whose IGF-1 was in the upper limit of normal values (0 ± 2 DS) versus low normal (−2–0 DS).
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