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
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Endocrinology - Malaysia digital copy today!
DOWNLOAD
Editor's Recommendations
Most Read Articles
21 Dec 2017
Vitamin C supplementation appears to yield significant reductions in glucose concentrations in patients with diabetes, particularly older individuals and those with more prolonged supplementation, according to a study.
26 Dec 2017
Supplementation with omega-3 fatty acids in combination with rosuvastatin may yield significant reductions in triglycerides and nonhigh-density lipoprotein (HDL) cholesterol as compared with rosuvastatin monotherapy, according to data from the ROMANTIC (rosuvastatin-omacor in residual hypertriglyceridemia) trial.
01 Jun 2015
New drug applications approved by US FDA as of 15 – 31 May 2015 which includes New Molecular Entities (NMEs) and new biologics. It does not include Tentative Approvals. Supplemental approvals may have occurred since the original approval date.
Jairia Dela Cruz, 27 Dec 2017
Individuals with obesity and high abdominal fat mass appear to have a twofold increased risk of developing psoriasis, as shown in a study. Long-term weight gain of ≥10 kg is also associated with a substantially increased risk.