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In patients with hypopituitarism, growth hormone (GH) deficiency is almost always present. Lack of other pituitary hormones may require prompt replacement, but lack of GH is also associated with several abnormalities, which can be improved by GH treatment. The aberrations include low bone mass and increased risk of fractures, abnormal body composition, e.g. increased fat mass and reduced lean body mass resulting in reduced muscle mass and strength. Decreased exercise capacity may be influenced by impaired cardiac performance and heat intolerance. Increased abdominal fat results in metabolic disturbancies, such as reduced insulin sensitivity and hyperlipidaemia, increasing the risk of cardiovascular diseases. Patients with hypopituitarism replaced with relevant hormones except GH have increased mortality due to cardiovascular diseases and increased morbidity. Thus, it is important to diagnose GH deficiency, which requires precise diagnostic criteria and methods. Dynamic testing of GH secretion with an insulin tolerance test or arginine plus GH-releasing hormone can be used.
Growth hormone, growth hormone deficiency, hypopituitarism, diagnosis, epidemiology
Disclosure: The author has no conflicts of interest to declare.
Received: 6 August 2010 Accepted: 20 September 2010 Citation: European Endocrinology, 2010;6(2):45–50
Correspondence: Torben Laursen, Department of Pharmacology, Bartholin Building, Vilhelm Meyers allé 4, University of Aarhus, DK-8000 Aarhus C, Denmark. E: firstname.lastname@example.org
Growth hormone (GH) therapy was introduced in the 1950s, but the initial GH preparations extracted from human cadaver pituitaries were reserved the treatment of GH deficiency (GHD) children.1 Since 1985, only recombinant DNA-derived biosynthetic human GH free from, for example, Creutzfeldt-Jakob prions has been used.2
GH has now been approved in many countries for the treatment of non-GHD patients with short stature, e.g. Turner’s syndrome, chronic renal failure, small size for gestational age, Prader-Willi syndrome and idiopathic short stature. Often GH therapy is discontinued once adult height has been achieved. Sustained GH deficiency in adult life is, however, associated with disturbances in body composition, carbohydrate and lipid metabolism, bone turnover, the cardiovascular system and quality of life.3–6 Moreover, GHD might contribute to the increased morbidity and mortality observed in hypopituitary adults.7,8
Several studies have demonstrated that GH therapy improves body composition, bone health, cardiovascular risk factors and quality of life in adult GHD (AGHD) and GH-replacement therapy has now been approved in many countries.9–13 Despite this, reductions in cardiovascular events and mortality still need to be demonstrated. Furthermore, although treatment appears to be safe, certain areas – such as risks of glucose intolerance, pituitary tumour regrowth and cancer – require long-term surveillance.14 Variable individual response to GH replacement is still a challenge, although the low GH doses used now are adjusted according to age, gender and body composition.