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GROWTH HORMONE DEFICIENCY
Growth hormone deficiency in adults reflects an absence of two hormones, growth hormone and insulin-like growth factor-1 (IGF-1), affecting the process of glucose-insulin metabolism, lipolysis and bone remodelling.
History may show pituitary adenoma, surgery &/or radiation treatment of pituitary adenomas or cranial radiation for other disorders, deficiency of other pituitary hormones that may occur concurrently with growth hormone deficiency, and previous childhood growth hormone deficiency.
Physical exam reveals reduced lean body mass with increased weight, body fat predominantly in the abdominal region, thin & dry skin, cool peripheries, poor venous access and blunt affect.

Differential Diagnosis

Endocrine Causes
  • Growth hormone resistance
  • Hypothyroidism
  • Cushing’s syndrome
  • Parathyroid or vitamin D disorders
  • Delayed puberty (GnRH deficiency)
Non-endocrine Causes
  • Syndromes (Turner, Noonan, Russell-Silver, etc)
  • Skeletal dysplasia
  • Chronic disease, inflammation
  • Psychosocial short stature
  • Constitutional delay of growth and puberty
  • Malnutrition
  • Intrauterine growth retardation (IUGR), small for gestational age (SGA)
IGF Deficiency
  • May be caused by GH insensitivity, IGF resistance, GH deficiency secondary to hypothalamic dysfunction or pituitary GH deficiency
Idiopathic Short Status (ISS)
  • Genetic and non-genetic short stature manifested as height of >2.25 SD below the corresponding mean height for age, sex and population group, with constitutional delayed growth and maturation
  • Systemic, endocrine, nutritional and chromosomal abnormalities, especially GHD should have been ruled out
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