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.

Definition

  • Growth hormone deficiency is a congenital or an acquired growth hormone (GH) axis disruption in the higher brain, hypothalamus or pituitary which results in short stature
  • May occur at any age

Signs and Symptoms

Children
  • Short stature
  • Severely decreased height velocity
  • Hypoglycemia or prolonged jaundice in the neonate

Adults

  • Growth hormone deficiency (GHD) syndrome
    • Decreased lean body mass & increased fat mass
    • Dyslipidemia, insulin resistance, vascular endothelial dysfunction
    • Reduced left ventricular mass, impaired systolic function
    • Reduced sweating
    • Impaired quality of life
  • Other clinical manifestations:
    • Lack of vigor
    • Emotional lability (eg depressed mood/affect)
    • Feeling of social isolation
    • Decreased exercise capacity
    • Reduced bone density & increased risk of fracture, osteopenia

Etiology

Adults

  • Growth hormone deficiency (GHD) in adults reflects an absence of 2 hormones, GH & insulin-like growth factor-1 (IGF-1), affecting the process of glucose-insulin metabolism, lipolysis & bone remodelling
  • Either adult-onset GHD (AOGHD) or childhood-onset (COGHD) & may occur as either isolated GHD or as multiple hormone deficiencies

Children

  • GHD in children reflects a congenital or an acquired GH axis disruption in the higher brain, hypothalamus or pituitary which results in short stature
  • Mainly idiopathic & usually identified because of growth failure
  • Exclude other causes of growth failure using appropriate tests
    • Eg hypothyroidism, chronic systemic diseases, skeletal diseases & Turner syndrome
  • Diagnose GH deficiency based on an integration of all results obtained from physical exam, radiological procedures & lab tests
  • In idiopathic isolated GHD of childhood (hypothalamic GHD), an insulin tolerance test (ITT) or glucagon stimulation tests are recommended
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