growth%20hormone%20deficiency
GROWTH HORMONE DEFICIENCY
Treatment Guideline Chart
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 Hormone Deficiency References

  1. Ayuk J, Sheppard MC. Growth hormone and its disorders. Postgrad Med J. 2006 Jan;82(963):24-30. PMID: 16397076
  2. Gharib H, Cook DM, Saenger PH, et al; American Association of Clinical Endocrinologists Growth Hormone Task Force. American Association of Clinical Endocrinologists medical guidelines for clinical practice for growth hormone use in adults and children - 2003 update. Endocr Pract. 2003 Jan;9(1):64-76. doi: 10.4158/EP.9.1.64. PMID: 12917095
  3. Cook DM, Yuen KC, Biller BM, et al; American Association of Clinical Endocrinologists. American Association of Clinical Endocrinologists medical guidelines for clinical practice for growth hormone use in growth hormone-deficient adults and transition patients - 2009 update. Endocr Pract. 2009 Sep;15(Suppl 2):001-29. PMID: 20228036
  4. Berg C, Meinel T, Lahner H, et al. Diagnostic utility of the glucagon stimulation test in comparison to the insulin tolerance test in patients following pituitary surgery. Eur J Endocrinol. 2010 Mar;162(3):477-482. PMID: 19996199
  5. Molitch ME, Clemmons DR, Malozowski S, et al; Endocrine Society's Clinical Guidelines Subcommittee. Evaluation and treatment of adult growth hormone deficiency: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2006 May;91(5):1621-1634. PMID: 16636129
  6. Growth Hormone Research Society. Consensus guidelines for the diagnosis and treatment of growth hormone (GH) deficiency in childhood and adolescence: summary statement of the GH Research Society. J Clin Endocrinol Metab. 2000 Nov;85(11):3990-3993. http://dx.doi.org/10.1210/jcem.85.11.6984. PMID: 11095419
  7. Stavrou S, Kleinberg DL. Diagnosis and management of growth hormone deficiency in adults. Endocrinol Metab Clin North Am. 2001 Sep;30(3):545-563. PMID: 11571930
  8. Yuen KC. Glucagon testing in adult growth hormone deficiency - current status and future perspectives. European Endocrinology. 2011;7(2):104-107
  9. Growth hormone replacement in adults with growth hormone deficiency. Harrison's Online: McGraw-Hill Companies; 2003. http://harrisonsonline.com
  10. MedWormhttp://www.medworm.com/rss/index.php/Endocrinology/15/http://www.medworm.com/rss/medicalfeeds/specialities/Endocrinology.xml
  11. MedWormhttp://www.medworm.com/rss/index.php/Pediatrics/33/http://www.medworm.com/rss/medicalfeeds/specialities/Pediatrics.xml
  12. Growth hormone deficiency. Children’s Hospital of Wisconsin. http://www.chw.org/.
  13. Kemp S. Pediatric growth hormone deficiency. eMedicine. http://emedicine.medscape.com/. Sep 2008.
  14. Eledrisi MS. Growth hormone deficiency. eMedicine. http://emedicine.medscape.com/. Jun 2008.
  15. Backeljauw PF, Dattani MT, Cohen P, et al. Disorders of growth hormone/insulin-like growth factor secretion and action. In: Perling MA. Pediatric Endocrinology. 4th ed. Philadelphia, PA: Saunders, Elsevier Inc; 2014.
  16. Ho, KKY. Consensus guidelines for the diagnosis and treatment of adults with GH deficiency II: a statement of the GH Research Society in association with the European Society for Pediatric Endocrinology, Lawson Wilkins Society, European Society of Endocrinology, Japan Endocrine Society, and Endocrine Society of Australia. European Journal of Endocrinology. 2007;157:695-700. doi: 10.1530/EJE-07-063.
  17. Molitch ME, Clemmons DR, Malozowski S, et al for The Endocrine Society’s Clinical Guidelines Subcommittee. Clinical practice guideline. Evaluation and treatment of adult growth hormone deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96(6):1587-1609. https://www.endocrine.org/. Accessed 7 May 2014. PMID: 21602453
  18. Wood AJ. Growth hormone therapy in adults and children. N Engl J Med. 1999;341(16):1206-1216.
  19. Ministry of Health Malaysia. The use of growth hormone in children and adults. MOH (Malaysia). http://www.moh.gov.my/. Nov 2010.
  20. Allen DB, Backeljauw P, Bidlingmaier M, et al. GH safety workshop position paper: a critical appraisal of recombinant human GH therapy in children and adults. Eur J Endocrinol. 2016 Feb;174(2):P1-P9. http://www.eje-online.org/. Accessed 16 Nov 2017. PMID: 26563978
  21. Cohen P, Rogol AD, Deal CL, et al; 2007 ISS Consensus Workshop Participants. Consensus statement on the diagnosis and treatment of children with idiopathic short stature: a summary of the Growth Hormone Research Society, the Lawson Wilkins Pediatric Endocrine Society, and the European Society for Paediatric Endocrinology Workshop. J Clin Endocrinol Metab. 2008 Nov;93(11):4210-4217. doi: 10.1210/jc.2008-0509. Accessed 09 Nov 2017. PMID: 18782877
  22. Grimberg A, DiVall SA, Polychronakos C, et al; Drug and Therapeutics Committee and Ethics Committee of the Pediatric Endocrine Society. Guidelines for growth hormone and insulin-like growth factor-I treatment in children and adolescents: growth hormone deficiency, idiopathic short stature, and primary insulin-like growth factor-I deficiency. Horm Res Paediatr. 2016;86(6):361-397. doi: 10.1159/000452150. PMID: 27884013
  23. Richmond EJ, Rogol AD. Diagnosis of growth hormone deficiency in children. UpToDate. https://www.uptodate.com/. Oct 2017. Accessed 16 Nov 2017.
  24. Snyder PJ. Growth hormone deficiency in adults. UpToDate. https://www.uptodate.com. Oct 2017. Accessed 16 Nov 2017.
  25. Alexopoulou O, Maiter D. An update on diagnosis and treatment of adult growth hormone deficiency. Louvain Med. 2018;137(3):123-130. Accessed 8 Mar 2020
  26. Bozzola M, Meazza C. Growth hormone deficiency: diagnosis and therapy in children. In: Cardenas-Aguayo, ed. Restricted Growth - Clinical Genetic and Molecular Aspects; 2016. :45-72.
  27. Deodati A, Cianfarani S. The rationale for growth hormone therapy in children with short stature. J Clin Res Pediatr Endocrinol. 2017 Dec;9(Suppl 2):23-32. doi: 10.4274/jcrpe.2017.S003. Accessed 6 Apr 2020. PMID: 29280742
  28. Díez JJ, Sangiao-Alvarellos S, Cordido F. Treatment with growth hormone therapy for adults with growth hormone deficiency syndrome: benefits and risks. Int J Mol Sci. 2018 Mar;19(3):893. doi: 10.3390/ijms19030893. PMID: 29562611
  29. Feldt-Rasmussen U, Klose M. Adult growth hormone deficiency clinical management. In: Feingold KR, Anawalt B, Boyce A, et al, eds. Endotext. South Dartmouth (MA): MDText.com, Inc; 2000.
  30. Gabreanu GR. An update on the diagnosis of growth hormone deficiency. Discoveries. 2018 Jan;6(1):e82. doi: 0.15190/d.2018.2.
  31. Garcia JM, Biller BMK, Korbonits M, et al. Macimorelin as a diagnostic test for adult GH deficiency. J Clin Endocrinol Metab. 2018 Aug;103(8):3083-3093. doi: 10.1210/jc.2018-00665. PMID: 29860473
  32. Stanley T. Diagnosis of growth hormone deficiency in childhood. Curr Opin Endocrinol Diabetes Obes. 2012 Feb;19(1):47-52. doi: 10.1097/MED.0b013e32834ec952. Accessed 11 Mar 2020. PMID: 22157400
  33. Yuen KC, Biller BMK, Radovick S, et al. American Association of Clinical Endocrinologists and American College of Endocrinology guidelines for management of growth hormone deficiency in adults and patients transitioning from pediatric to adult care. Endocr Pract. 2019 Nov;25(11):1191-1232. doi: 10.4158/GL-2019-0405. PMID: 31760824
Editor's Recommendations
Special Reports