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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

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  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
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  12. Growth hormone deficiency. Children’s Hospital of Wisconsin. http://www.chw.org/.
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  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.
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  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
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  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
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