Growth Hormone Replacement for Patients With Adult Onset Growth Hormone Deficiency -- What We Have Learned

Monique Piersanti, M.D., F.R.C.P.(C)., M.Sc.


Neurosurg Focus. 2004;16(4) 

In This Article

Abstract and Introduction

Growth hormone (GH) deficiency is a condition recognized to occur in individuals who have had multiple pituitary hormone deficiencies as a result of pathological processes or neurosurgical interventions. The indications, benefits, and risks of GH replacement therapy will be reviewed with an emphasis on those patients who were adults with the deficiency first emerged. The results of this analysis indicate that, although a measurable improvement can be detected in the patient's quality of life, body composition, and some cardiovascular parameters, the larger questions of long-term benefit and patient selection currently remain unanswered.

With the introduction of rhGH in 1985, the possibility of hormone replacement therapy for a number of clinical scenarios became possible. Adults who experience GHD have been well recognized to exhibit a number of clinical and biochemical findings currently labeled GHD syndrome ( Table 1 ). The diagnosis of this condition and the indications for hormone replacement are not, however, a straightforward process because we still lack a complete understanding of the benefits and potential adverse effects of rhGH therapy.

The purpose of this review is to highlight the following issues: 1) diagnosis of adult-onset GHD; 2) the dosing of appropriate hormone replacement therapy; 3) effects of this hormone replacement therapy; and 4) safety of the therapy. The focus of this discussion is on patients who experience GHD due to pituitary–hypothalamic disease incurred in adulthood and the findings and recommendations should not be applied to child-onset GHD nor other situations in which GH levels decline as part of the patient's normal physiology, as in aging, or another disease process.