GROWTH HORMONE DEFICIENCY

Extensive research has led to improved characterization of the consequences of GH deficiency in adults and to a better understanding of the risks and benefits of treatment. Patient subgroups include those who have childhood-onset GH deficiency that persists into adulthood and those who have adult-onset GH deficiency. Although the presentation and response to therapy overlap considerably, variation between the subgroups has been noted.33 The adult-onset subgroup frequently has other concomitant pituitary hormone deficiencies. Both subgroups may exhibit a varied constellation of symptoms and signs, and often have difficult diagnostic and management issues. GH replacement is expensive, requires many resources, and provides variable—
although often profound—benefit to adult patients. Therefore, it is important to identify patients at risk for GH deficiency and prudently utilize confirmatory diagnostic tests on the patients who might be appropriate candidates for GH replacement. Because of the complexity of the diagnostic and management issues surrounding GH deficiency in adults, it is advisable to have an endocrinologist involved throughout the care of these patients.

SYMPTOMS

Adult patients with GH deficiency may report increased abdominal adiposity and reduced muscle mass that leads to decreased strength, reduced vitality and energy, and a diminished exercise capacity. Impaired psychological well-being is a major component of the GH deficiency syndrome in adults. A depressed and sometimes labile mood, anxiety, and social isolation are common symptoms.34 Children with GH deficiency may report short stature compared with peers. A history of childhood GH deficiency should be sought in all patients with suspected hypopituitarism.

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