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growth%20hormone%20deficiency
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.

Growth%20hormone%20deficiency Management

Follow Up

Adults

  • Monitor monthly initially for response to treatment and adjust dose accordingly
  • Plasma glucose should be checked initially and every 3 months
  • Once maintenance doses are achieved, measurement of serum fasting blood sugar (FBS), insulin-like growth factor 1 (IGF-1), hemoglobin A1c (HbA1c), waist circumference, body mass index (BMI), serum free T4, and clinical assessment of hypothalamic-pituitary-adrenal axis or by early morning cortisol or cosyntropin stimulation test (in patients not on glucocorticoid replacement), testosterone, and fasting lipid panel should be done every 6-12 months
  • DEXA (Dual Energy X-ray Absorptiometry) scan is recommended prior to and during growth hormone (GH) therapy
    • 1st DEXA scan after initiation of GH replacement should be done at approximately 2 years later and repeated at 2-3 year intervals
  • MRI is recommended at baseline in patients with any postsurgical tumor remnant in the hypothalamic-pituitary region before starting GH therapy
    • Periodic MRI is recommended while on GH therapy

Children

  • Close follow-up care with an endocrinologist is recommended to monitor the child’s growth, assessment of potential adverse effects, and to adjust the dose of GH therapy
  • Initial follow-up should be every month; thereafter, visits may be less frequent but should be at least 2x/year
  • Monitor every 3-6 months for response to treatment and adjust dose accordingly
  • Monitor thyroid function every 6 months
  • Continue GH therapy if there is persistent growth hormone deficiency (GHD) even after adult height is achieved to obtain full skeletal/muscle maturation during the transition period
  • GHD may persist to adult life
    • Retesting may be required esp in idiopathic GHD patients (retest using adult criteria after 1-3 months without GH therapy)
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