Description of the progresses related to the complications and treatment of adult-onset growth hormone deficiency.
Growth hormone deficiency in adults has gained attention as a clinical syndrome associated with increased morbidity and possibly mortality. Many studies have been conducted on the consequences of growth hormone deficiency and of its replacement, supporting its use in appropriate patients. Early studies were characterized by a high incidence of side effects due to a lack of pilot data to guide appropriate dosing. Given the wide variability in individual responsiveness to growth hormone therapy based on age, sex, and body composition, recent work has been dedicated to understanding which patients derive benefit from therapy, minimizing side effects, and ensuring cost–effectiveness.
Long-term prospective trials have shown that growth hormone replacement therapy results in improvements in body composition, dyslipidemia, bone mineral density, and quality of life. The effects on endpoints such as cardiovascular morbidity and mortality and fractures are, however, not fully proven. Randomized trials that compare homogenous groups of growth hormone deficiency patients are still needed. Given the high cost of treatment, dynamic testing for growth hormone deficiency should only be performed in patients in whom there is high clinical suspicion, and therapy should be limited to those with biochemically proven growth hormone deficiency.
Division of Endocrinology and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland USA
Correspondence to Roberto Salvatori, MD, Johns Hopkins School of Medicine, Division of Endocrinology and Metabolism, 1830 East Monument Street, Suite 333, Baltimore, MD 21287, USA Tel: +1 410 955 3921; fax: +1 410 955 8172; e-mail: firstname.lastname@example.org