GH Replacement Therapy in GH-Deficient Adults
Journal für Reproduktionsmedizin und Endokrinologie - Journal of Reproductive Medicine and Endocrinology 2006; 3 (6): 379-381
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Keywords: Insulintoleranz, kardiovaskuläres Risiko, Mortalität, Test, Therapie, Wachstumshormon, cardiovascular risk, growth hormone deficiency, growth hormone therapy, insulin tolerance test, mortality
Growth hormone (GH) deficiency represents an indication for substitution therapy not only in children but also in adults. In the last twenty years, numerous studies have shown that GH deficiency in adults is characterized by a clearly defined syndrome which is associated with a doubleincreased mortality rate. GH deficiency in adults can be diagnosed only by dynamic tests. While the insulin tolerance test (ITT) has been the standard test in the past, the combined arginine-GH releasing hormone (GHRH) test has been used more often in the last years. It has the advantage to detect more readily GH deficiency in obese and elderly subjects. Severe GH deficiency is characterised by a maximal GH concentration of less than 3 ng/ml in the ITT, and less than 9 ng/ml in the arginine-GHRH test. Severe growth hormone deficiency represents a clear indication for GH substitution therapy which should be started in a dose of 0.15–0.30 mg/day. The GH dose should be adapted according to the age- and sex-specific reference ranges for insulin-like growth factor 1 (IGF-1). GH substitution therapy can reverse or at least ameliorate most of the symptoms of GH deficiency. Side effects such as muscle and joint aches as well as fluid retention can be observed sometimes at start of therapy. The incidence of diabetes mellitus and carcinomas is not increased by GH therapy. As is the case with other pituitary deficiencies, GH substitution therapy in adults with GH deficiency represents an established indication.