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Physiopathology, Diagnosis, and Treatment of GH Deficiency

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Hypothalamic-Pituitary Diseases

Part of the book series: Endocrinology ((ENDOCR))

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Abstract

Growth hormone deficiency (GHD) in adults arises due to decreased secretion of GH from the pituitary gland. Until two decades ago, GHD in adults was not accepted as a clinical syndrome, and it was supposed that GH has little physiologic effects after adolescence. However after the advent of recombinant GH, physiologic role of GH becomes clearer in the adult life, and the studies during the last two decades revealed GHD as a real disease associated with a plenty of clinical manifestations. GHD is one of the most common hormonal deficiencies in adults with hypopituitarism due to variety of causes. In the present chapter, acquired causes, pathophysiology, diagnosis, and treatment of GHD in adults will be discussed based on the recent advances in the literature.

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References

  • Abs R, Bengtsson BA, Hernberg-Stahl E, Monson JP, Tauber JP, Wilton P, Wuster C. GH replacement in 1034 growth hormone deficient hypopituitary adults: demographic and clinical characteristics, dosing and safety. Clin Endocrinol. 1999;50:703.

    Article  CAS  Google Scholar 

  • Abs R, Mattsson AF, Bengtsson BA, Feldt-Rasmussen U, Goth MI, Koltowska-Haggstrom M, Monson JP, Verhelst J, Wilton P. Isolated growth hormone (GH) deficiency in adult patients: baseline clinical characteristics and responses to GH replacement in comparison with hypopituitary patients. A sub-analysis of the KIMS database. Growth Horm IGF Res. 2005;15:349.

    Article  CAS  PubMed  Google Scholar 

  • Abs R, Feldt-Rasmussen U, Mattsson AF, Monson JP, Bengtsson BA, Goth MI, Wilton P, Koltowska-Haggstrom M. Determinants of cardiovascular risk in 2589 hypopituitary GH-deficient adults – a KIMS database analysis. Eur J Endocrinol. 2006;155:79.

    Article  CAS  PubMed  Google Scholar 

  • Aimaretti G, Corneli G, Razzore P, Bellone S, Baffoni C, Arvat E, Camanni F, Ghigo E. Comparison between insulin-induced hypoglycemia and growth hormone (GH)-releasing hormone + arginine as provocative tests for the diagnosis of GH deficiency in adults. J Clin Endocrinol Metab. 1998;83:1615.

    CAS  PubMed  Google Scholar 

  • Allen DB, Backeljauw P, Bidlingmaier M, Biller BM, Boguszewski M, Burman P, Butler G, Chihara K, Christiansen J, Cianfarani S, Clayton P, Clemmons D, Cohen P, Darendeliler F, Deal C, Dunger D, Erfurth EM, Fuqua JS, Grimberg A, Haymond M, Higham C, Ho K, Hoffman AR, Hokken-Koelega A, Johannsson G, Juul A, Kopchick J, Lee P, Pollak M, Radovick S, Robison L, Rosenfeld R, Ross RJ, Savendahl L, Saenger P, Toft SH, Stochholm K, Strasburger C, Swerdlow A, Thorner M. GH safety workshop position paper: a critical appraisal of recombinant human GH therapy in children and adults. Eur J Endocrinol. 2016;174:1.

    Article  CAS  Google Scholar 

  • Amato G, Carella C, Fazio S, La Montagna G, Cittadini A, Sabatini D, Marciano-Mone C, Sacca L, Bellastella A. Body composition, bone metabolism, and heart structure and function in growth hormone (GH)-deficient adults before and after GH replacement therapy at low doses. J Clin Endocrinol Metab. 1993;77:1671.

    CAS  PubMed  Google Scholar 

  • Appelman-Dijkstra NM, Claessen KM, Roelfsema F, Pereira AM, Biermasz NR. Long-term effects of recombinant human GH replacement in adults with GH deficiency: a systematic review. Eur J Endocrinol. 2013;169:R1.

    Article  CAS  PubMed  Google Scholar 

  • Arafah BM. Reversible hypopituitarism in patients with large nonfunctioning pituitary adenomas. J Clin Endocrinol Metab. 1986;62:1173.

    Article  CAS  PubMed  Google Scholar 

  • Arafah BM, Prunty D, Ybarra J, Hlavin ML, Selman WR. The dominant role of increased intrasellar pressure in the pathogenesis of hypopituitarism, hyperprolactinemia, and headaches in patients with pituitary adenomas. J Clin Endocrinol Metab. 2000;85:1789.

    CAS  PubMed  Google Scholar 

  • Attanasio AF, Lamberts SW, Matranga AM, Birkett MA, Bates PC, Valk NK, Hilsted J, Bengtsson BA, Strasburger CJ. Adult growth hormone (GH)-deficient patients demonstrate heterogeneity between childhood onset and adult onset before and during human GH treatment. Adult Growth Hormone Deficiency Study Group. J Clin Endocrinol Metab. 1997;82:82.

    CAS  PubMed  Google Scholar 

  • Attanasio AF, Mo D, Erfurth EM, Tan M, Ho KY, Kleinberg D, Zimmermann AG, Chanson P. Prevalence of metabolic syndrome in adult hypopituitary growth hormone (GH)-deficient patients before and after GH replacement. J Clin Endocrinol Metab. 2010;95:74.

    Article  CAS  PubMed  Google Scholar 

  • Bates AS, Van’t Hoff W, Jones PJ, Clayton RN. The effect of hypopituitarism on life expectancy. J Clin Endocrinol Metab. 1996;81:1169.

    CAS  PubMed  Google Scholar 

  • Baxter D, Sharp DJ, Feeney C, Papadopoulou D, Ham TE, Jilka S, Hellyer PJ, Patel MC, Bennett AN, Mistlin A, McGilloway E, Midwinter M, Goldstone AP. Pituitary dysfunction after blast traumatic brain injury: the UK BIOSAP study. Ann Neurol. 2013;74:527.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Bell J, Parker KL, Swinford RD, Hoffman AR, Maneatis T, Lippe B. Long-term safety of recombinant human growth hormone in children. J Clin Endocrinol Metab. 2010;95:167.

    Article  CAS  PubMed  Google Scholar 

  • Biller BM, Sesmilo G, Baum HB, Hayden D, Schoenfeld D, Klibanski A. Withdrawal of long-term physiological growth hormone (GH) administration: differential effects on bone density and body composition in men with adult-onset GH deficiency. J Clin Endocrinol Metab. 2000;85:970.

    CAS  PubMed  Google Scholar 

  • Biller BM, Samuels MH, Zagar A, Cook DM, Arafah BM, Bonert V, Stavrou S, Kleinberg DL, Chipman JJ, Hartman ML. Sensitivity and specificity of six tests for the diagnosis of adult GH deficiency. J Clin Endocrinol Metab. 2002;87:2067.

    Article  CAS  PubMed  Google Scholar 

  • Birzniece V, Sata A, Ho KK. Growth hormone receptor modulators. Rev Endocr Metab Disord. 2009;10:145.

    Article  CAS  PubMed  Google Scholar 

  • Bollerslev J, Ueland T, Jorgensen AP, Fougner KJ, Wergeland R, Schreiner T, Burman P. Positive effects of a physiological dose of GH on markers of atherogenesis: a placebo-controlled study in patients with adult-onset GH deficiency. Eur J Endocrinol. 2006;154:537.

    Article  CAS  PubMed  Google Scholar 

  • Bonert VS, Elashoff JD, Barnett P, Melmed S. Body mass index determines evoked growth hormone (GH) responsiveness in normal healthy male subjects: diagnostic caveat for adult GH deficiency. J Clin Endocrinol Metab. 2004;89:3397.

    Article  CAS  PubMed  Google Scholar 

  • Borson-Chazot F, Serusclat A, Kalfallah Y, Ducottet X, Sassolas G, Bernard S, Labrousse F, Pastene J, Sassolas A, Roux Y, Berthezene F. Decrease in carotid intima-media thickness after one year growth hormone (GH) treatment in adults with GH deficiency. J Clin Endocrinol Metab. 1999;84:1329.

    CAS  PubMed  Google Scholar 

  • Brabant G, Poll EM, Jonsson P, Polydorou D, Kreitschmann-Andermahr I. Etiology, baseline characteristics, and biochemical diagnosis of GH deficiency in the adult: are there regional variations? Eur J Endocrinol. 2009;161(Suppl 1):S25.

    Article  CAS  PubMed  Google Scholar 

  • Burman P, Mattsson AF, Johannsson G, Hoybye C, Holmer H, Dahlqvist P, Berinder K, Engstrom BE, Ekman B, Erfurth EM, Svensson J, Wahlberg J, Karlsson FA. Deaths among adult patients with hypopituitarism: hypocortisolism during acute stress, and de novo malignant brain tumors contribute to an increased mortality. J Clin Endocrinol Metab. 2013;98:1466.

    Article  CAS  PubMed  Google Scholar 

  • Carroll PV, Christ ER, Bengtsson BA, Carlsson L, Christiansen JS, Clemmons D, Hintz R, Ho K, Laron Z, Sizonenko P, Sonksen PH, Tanaka T, Thorne M. Growth hormone deficiency in adulthood and the effects of growth hormone replacement: a review. Growth Hormone Research Society Scientific Committee. J Clin Endocrinol Metab. 1998;83:382.

    Article  CAS  PubMed  Google Scholar 

  • Cenci MC, Soares DV, Spina LD, de Lima Oliveira Brasil RR, Lobo PM, Mansur VA, Gold J, Michmacher E, Vaisman M, Conceicao FL. Effects of 5 years of growth hormone (GH) replacement therapy on cardiac parameters and physical performance in adults with GH deficiency. Pituitary. 2009;12:322.

    Article  CAS  PubMed  Google Scholar 

  • Clayton PE, Cuneo RC, Juul A, Monson JP, Shalet SM, Tauber M. Consensus statement on the management of the GH-treated adolescent in the transition to adult care. Eur J Endocrinol. 2005;152:165.

    Article  CAS  PubMed  Google Scholar 

  • Clemmons DR. The relative roles of growth hormone and IGF-1 in controlling insulin sensitivity. J Clin Invest. 2004;113:25.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Colao A, Marzullo P, Di Somma C, Lombardi G. Growth hormone and the heart. Clin Endocrinol. 2001;54:137.

    Article  CAS  Google Scholar 

  • Cook DM, Yuen KC, Biller BM, Kemp SF, Vance ML. American Association of Clinical Endocrinologists medical guidelines for clinical practice for growth hormone use in growth hormone-deficient adults and transition patients – 2009 update. Endocr Pract. 2009;15(Suppl 2):1.

    Article  PubMed  Google Scholar 

  • Corneli G, Di Somma C, Baldelli R, Rovere S, Gasco V, Croce CG, Grottoli S, MacCario M, Colao A, Lombardi G, Ghigo E, Camanni F, Aimaretti G. The cut-off limits of the GH response to GH-releasing hormone-arginine test related to body mass index. Eur J Endocrinol. 2005;153:257.

    Article  CAS  PubMed  Google Scholar 

  • Cuneo RC, Salomon F, McGauley GA, Sonksen PH. The growth hormone deficiency syndrome in adults. Clin Endocrinol (Oxf). 1992;37:387.

    Article  CAS  Google Scholar 

  • Cuneo RC, Judd S, Wallace JD, Perry-Keene D, Burger H, Lim-Tio S, Strauss B, Stockigt J, Topliss D, Alford F, Hew L, Bode H, Conway A, Handelsman D, Dunn S, Boyages S, Cheung NW, Hurley D. The Australian multicenter trial of growth hormone (GH) treatment in GH-deficient adults. J Clin Endocrinol Metab. 1998;83:107.

    CAS  PubMed  Google Scholar 

  • Darendeliler F, Karagiannis G, Wilton P, Ranke MB, Albertsson-Wikland K, Anthony PD, On Behalf of the Kigs International Board. Recurrence of brain tumours in patients treated with growth hormone: analysis of KIGS (Pfizer International Growth Database). Acta Paediatr. 2006;95:1284.

    Article  PubMed  Google Scholar 

  • Darzy KH. Radiation-induced hypopituitarism. Curr Opin Endocrinol Diabetes Obes. 2013;20:342.

    Article  CAS  PubMed  Google Scholar 

  • Deodati A, Ferroli BB, Cianfarani S. Association between growth hormone therapy and mortality, cancer and cardiovascular risk: systematic review and meta-analysis. Growth Horm IGF Res. 2014;24:105.

    Article  CAS  PubMed  Google Scholar 

  • Diri H, Karaca Z, Simsek Y, Tanriverdi F, Unluhizarci K, Kelestimur F. Can a glucagon stimulation test characterized by lower GH cut-off value be used for the diagnosis of growth hormone deficiency in adults? Pituitary. 2015;18:884.

    Article  CAS  PubMed  Google Scholar 

  • Diri H, Karaca Z, Tanriverdi F, Unluhizarci K, Kelestimur F. Sheehan’s syndrome: new insights into an old disease. Endocrine. 2016;51:22.

    Article  CAS  PubMed  Google Scholar 

  • Dusick JR, Wang C, Cohan P, Swerdloff R, Kelly DF. Pathophysiology of hypopituitarism in the setting of brain injury. Pituitary. 2012;15:2.

    Article  PubMed  PubMed Central  Google Scholar 

  • Elbornsson M, Gotherstrom G, Bosaeus I, Bengtsson BA, Johannsson G, Svensson J. Fifteen years of GH replacement improves body composition and cardiovascular risk factors. Eur J Endocrinol. 2013;168:745.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Elumir- Mamba LAS, Andag-Silva AA, Fonte JS, Mercado-Asis LB. Clinical profile and etiology of hypopituitarism at the University of Santo Tomas Hospital. Philipp J Intern Med. 2010;48:23.

    Google Scholar 

  • Fernandez-Rodriguez E, Lopez-Raton M, Andujar P, Martinez-Silva IM, Cadarso-Suarez C, Casanueva FF, Bernabeu I. Epidemiology, mortality rate and survival in a homogeneous population of hypopituitary patients. Clin Endocrinol (Oxf). 2013;78:278.

    Article  CAS  Google Scholar 

  • Ghigo E, Aimaretti G, Gianotti L, Bellone J, Arvat E, Camanni F. New approach to the diagnosis of growth hormone deficiency in adults. Eur J Endocrinol. 1996;134:352.

    Article  CAS  PubMed  Google Scholar 

  • Giavoli C, Libe R, Corbetta S, Ferrante E, Lania A, Arosio M, Spada A, Beck-Peccoz P. Effect of recombinant human growth hormone (GH) replacement on the hypothalamic-pituitary-adrenal axis in adult GH-deficient patients. J Clin Endocrinol Metab. 2004;89:5397.

    Article  CAS  PubMed  Google Scholar 

  • Gibney J, Wallace JD, Spinks T, Schnorr L, Ranicar A, Cuneo RC, Lockhart S, Burnand KG, Salomon F, Sonksen PH, Russell-Jones D. The effects of 10 years of recombinant human growth hormone (GH) in adult GH-deficient patients. J Clin Endocrinol Metab. 1999;84:2596.

    Article  CAS  PubMed  Google Scholar 

  • Golgeli A, Tanriverdi F, Suer C, Gokce C, Ozesmi C, Bayram F, Kelestimur F. Utility of P300 auditory event related potential latency in detecting cognitive dysfunction in growth hormone (GH) deficient patients with Sheehan’s syndrome and effects of GH replacement therapy. Eur J Endocrinol. 2004;150:153.

    Article  CAS  PubMed  Google Scholar 

  • Gomez JM, Espadero RM, Escobar-Jimenez F, Hawkins F, Pico A, Herrera-Pombo JL, Vilardell E, Duran A, Mesa J, Faure E, Sanmarti A. Growth hormone release after glucagon as a reliable test of growth hormone assessment in adults. Clin Endocrinol. 2002;56:329.

    Article  CAS  Google Scholar 

  • Gotherstrom G, Elbornsson M, Stibrant-Sunnerhagen K, Bengtsson BA, Johannsson G, Svensson J. Ten years of growth hormone (GH) replacement normalizes muscle strength in GH-deficient adults. J Clin Endocrinol Metab. 2009;94:809.

    Article  PubMed  CAS  Google Scholar 

  • Hamrahian AH, Yuen KC, Gordon MB, Pulaski-Liebert KJ, Bena J, Biller BM. Revised GH and cortisol cut-points for the glucagon stimulation test in the evaluation of GH and hypothalamic-pituitary-adrenal axes in adults: results from a prospective randomized multicenter study. Pituitary. 2016;19:332.

    Article  CAS  PubMed  Google Scholar 

  • Hartman ML, Crowe BJ, Biller BM, Ho KK, Clemmons DR, Chipman JJ. Which patients do not require a GH stimulation test for the diagnosis of adult GH deficiency? J Clin Endocrinol Metab. 2002;87:477.

    Article  CAS  PubMed  Google Scholar 

  • Ho KK. Consensus guidelines for the diagnosis and treatment of adults with GH deficiency II: a statement of the GH Research Society in association with the European Society for Pediatric Endocrinology, Lawson Wilkins Society, European Society of Endocrinology, Japan Endocrine Society, and Endocrine Society of Australia. Eur J Endocrinol. 2007;157:695.

    Article  CAS  PubMed  Google Scholar 

  • Hodis HN, Mack WJ, LaBree L, Selzer RH, Liu CR, Liu CH, Azen SP. The role of carotid arterial intima-media thickness in predicting clinical coronary events. Ann Intern Med. 1998;128:262.

    Article  CAS  PubMed  Google Scholar 

  • Hoffman DM, O’Sullivan AJ, Freund J, Ho KK. Adults with growth hormone deficiency have abnormal body composition but normal energy metabolism. J Clin Endocrinol Metab. 1995;80:72.

    CAS  PubMed  Google Scholar 

  • Hoffman AR, Kuntze JE, Baptista J, Baum HB, Baumann GP, Biller BM, Clark RV, Cook D, Inzucchi SE, Kleinberg D, Klibanski A, Phillips LS, Ridgway EC, Robbins RJ, Schlechte J, Sharma M, Thorner MO, Vance ML. Growth hormone (GH) replacement therapy in adult-onset gh deficiency: effects on body composition in men and women in a double-blind, randomized, placebo-controlled trial. J Clin Endocrinol Metab. 2004;89:2048.

    Article  CAS  PubMed  Google Scholar 

  • Holmes SJ, Shalet SM. Which adults develop side-effects of growth hormone replacement? Clin Endocrinol (Oxf). 1995;43:143.

    Article  CAS  Google Scholar 

  • Holmes SJ, Economou G, Whitehouse RW, Adams JE, Shalet SM. Reduced bone mineral density in patients with adult onset growth hormone deficiency. J Clin Endocrinol Metab. 1994;78:669.

    CAS  PubMed  Google Scholar 

  • Ismailogullari S, Tanriverdi F, Kelestimur F, Aksu M. Sleep architecture in Sheehan’s syndrome before and 6 months after growth hormone replacement therapy. Psychoneuroendocrinology. 2009;34:212.

    Article  CAS  PubMed  Google Scholar 

  • Johannsson G, Grimby G, Sunnerhagen KS, Bengtsson BA. Two years of growth hormone (GH) treatment increase isometric and isokinetic muscle strength in GH-deficient adults. J Clin Endocrinol Metab. 1997;82:2877.

    CAS  PubMed  Google Scholar 

  • Karaca Z, Tanriverdi F, Unluhizarci K, Kelestimur F. Pregnancy and pituitary disorders. Eur J Endocrinol. 2010;162:453.

    Article  CAS  PubMed  Google Scholar 

  • Karaca Z, Tanriverdi F, Dagli AT, Selcuklu A, Casanueva FF, Unluhizarci K, Kelestimur F. Three years prospective investigation of pituitary functions following subarachnoid haemorrhage. Pituitary. 2013;16:76.

    Article  CAS  PubMed  Google Scholar 

  • Kelestimur F. Sheehan’s syndrome. Pituitary. 2003;6:181.

    Article  PubMed  Google Scholar 

  • Kelestimur F. Chronic trauma in sports as a cause of hypopituitarism. Pituitary. 2005;8:259.

    Article  PubMed  Google Scholar 

  • Kelestimur F, Jonsson P, Molvalilar S, Gomez JM, Auernhammer CJ, Colak R, Koltowska-Haggstrom M, Goth MI. Sheehan’s syndrome: baseline characteristics and effect of 2 years of growth hormone replacement therapy in 91 patients in K. Eur J Endocrinol. 2005;152:581.

    Article  CAS  PubMed  Google Scholar 

  • Kelestimur F, Popovic V, Leal A, Van Dam PS, Torres E, Perez Mendez LF, Greenman Y, Koppeschaar HP, Dieguez C, Casanueva FF. Effect of obesity and morbid obesity on the growth hormone (GH) secretion elicited by the combined GHRH + GHRP-6 test. Clin Endocrinol (Oxf). 2006;64:667.

    Article  CAS  Google Scholar 

  • Kelly DF, Gonzalo IT, Cohan P, Berman N, Swerdloff R, Wang C. Hypopituitarism following traumatic brain injury and aneurysmal subarachnoid hemorrhage: a preliminary report. J Neurosurg. 2000;93:743.

    Article  CAS  PubMed  Google Scholar 

  • Kelly DF, Chaloner C, Evans D, Mathews A, Cohan P, Wang C, Swerdloff R, Sim MS, Lee J, Wright MJ, Kernan C, Barkhoudarian G, Yuen KC, Guskiewicz K. Prevalence of pituitary hormone dysfunction, metabolic syndrome, and impaired quality of life in retired professional football players: a prospective study. J Neurotrauma. 2014;31:1161.

    Article  PubMed  PubMed Central  Google Scholar 

  • Klose M, Jonsson B, Abs R, Popovic V, Koltowska-Haggstrom M, Saller B, Feldt-Rasmussen U, Kourides I. From isolated GH deficiency to multiple pituitary hormone deficiency: an evolving continuum – a KIMS analysis. Eur J Endocrinol. 2009;161(Suppl 1):S75.

    Article  CAS  PubMed  Google Scholar 

  • Kokshoorn NE, Wassenaar MJ, Biermasz NR, Roelfsema F, Smit JW, Romijn JA, Pereira AM. Hypopituitarism following traumatic brain injury: prevalence is affected by the use of different dynamic tests and different normal values. Eur J Endocrinol. 2010;162:11.

    Article  CAS  PubMed  Google Scholar 

  • Koller EA, Green L, Gertner JM, Bost M, Malozowski SN. Retinal changes mimicking diabetic retinopathy in two nondiabetic, growth hormone-treated patients. J Clin Endocrinol Metab. 1998;83:2380.

    CAS  PubMed  Google Scholar 

  • Koltowska-Haggstrom M, Mattsson AF, Shalet SM. Assessment of quality of life in adult patients with GH deficiency: KIMS contribution to clinical practice and pharmacoeconomic evaluations. Eur J Endocrinol. 2009;161(Suppl 1):S51.

    Article  PubMed  CAS  Google Scholar 

  • Kovacs K. Sheehan syndrome. Lancet. 2003;361:520.

    Article  PubMed  Google Scholar 

  • Kristjansdottir HL, Bodvarsdottir SP, Sigurjonsdottir HA. Sheehan’s syndrome in modern times: a nationwide retrospective study in Iceland. Eur J Endocrinol. 2011;164:349.

    Article  CAS  PubMed  Google Scholar 

  • Kronvall E, Valdemarsson S, Saveland H, Nilsson OG. High prevalence of pituitary dysfunction after aneurysmal subarachnoid hemorrhage: a long-term prospective study using dynamic endocrine testing. World Neurosurg. 2015;83:574.

    Article  PubMed  Google Scholar 

  • Lange M, Thulesen J, Feldt-Rasmussen U, Skakkebaek NE, Vahl N, Jorgensen JO, Christiansen JS, Poulsen SS, Sneppen SB, Juul A. Skin morphological changes in growth hormone deficiency and acromegaly. Eur J Endocrinol. 2001;145:147.

    Article  CAS  PubMed  Google Scholar 

  • Lissett CA, Shalet SM. Effects of growth hormone on bone and muscle. Growth Horm IGF Res. 2000;10(Suppl B):S95.

    Article  PubMed  Google Scholar 

  • Littley MD, Shalet SM, Beardwell CG, Ahmed SR, Applegate G, Sutton ML. Hypopituitarism following external radiotherapy for pituitary tumours in adults. Q J Med. 1989;70:145.

    CAS  PubMed  Google Scholar 

  • Maghnie M, Aimaretti G, Bellone S, Bona G, Bellone J, Baldelli R, de Sanctis C, Gargantini L, Gastaldi R, Ghizzoni L, Secco A, Tinelli C, Ghigo E. Diagnosis of GH deficiency in the transition period: accuracy of insulin tolerance test and insulin-like growth factor-I measurement. Eur J Endocrinol. 2005;152:589.

    Article  CAS  PubMed  Google Scholar 

  • Maison P, Chanson P. Cardiac effects of growth hormone in adults with growth hormone deficiency: a meta-analysis. Circulation. 2003;108:2648.

    Article  CAS  PubMed  Google Scholar 

  • Maison P, Griffin S, Beglah-Nicoue M, Haddad N, Balkau B, Chanson P. Impact of growth hormone (GH) treatment on cardiovascular risk factors in GH-deficient adults: a metaanalysis of blinded, randomized, placebo-controlled trials. J Clin Endocrinol Metab. 2004;89:2192.

    Article  CAS  PubMed  Google Scholar 

  • Malozowski S, Tanner LA, Wysowski D, Fleming GA. Growth hormone, insulin-like growth factor I, and benign intracranial hypertension. N Engl J Med. 1993;329:665.

    Article  CAS  PubMed  Google Scholar 

  • Mazziotti G, Bianchi A, Bonadonna S, Nuzzo M, Cimino V, Fusco A, De Marinis L, Giustina A. Increased prevalence of radiological spinal deformities in adult patients with GH deficiency: influence of GH replacement therapy. J Bone Miner Res. 2006;21:520.

    Article  CAS  PubMed  Google Scholar 

  • McGauley GA, Cuneo RC, Salomon F, Sonksen PH. Psychological well-being before and after growth hormone treatment in adults with growth hormone deficiency. Horm Res. 1990;33(Suppl 4):52.

    Article  PubMed  Google Scholar 

  • Melmed S. Idiopathic adult growth hormone deficiency. J Clin Endocrinol Metab. 2013;98:2187.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Molitch ME, Clemmons DR, Malozowski S, Merriam GR, Vance ML. Evaluation and treatment of adult growth hormone deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96:1587.

    Article  CAS  PubMed  Google Scholar 

  • Moller N, Jorgensen JO. Effects of growth hormone on glucose, lipid, and protein metabolism in human subjects. Endocr Rev. 2009;30:152.

    Article  PubMed  CAS  Google Scholar 

  • Murray RD, Skillicorn CJ, Howell SJ, Lissett CA, Rahim A, Smethurst LE, Shalet SM. Influences on quality of life in GH deficient adults and their effect on response to treatment. Clin Endocrinol (Oxf). 1999;51:565.

    Article  CAS  Google Scholar 

  • Nomikos P, Ladar C, Fahlbusch R, Buchfelder M. Impact of primary surgery on pituitary function in patients with non-functioning pituitary adenomas – a study on 721 patients. Acta Neurochir (Wien). 2004;146:27.

    Article  CAS  Google Scholar 

  • Ozdogru I, Tanriverdi F, Dogan A, Kaya MG, Tugrul IM, Kalay N, Topsakal R, Unluhizarci K, Atmaca H, Kemal EN, Kelestimur F. Impaired longitudinal myocardial velocities in patients with growth hormone deficiency improves after hormone replacement therapy. J Am Soc Echocardiogr. 2007;20:1093.

    Article  PubMed  Google Scholar 

  • Popovic V, Leal A, Micic D, Koppeschaar HP, Torres E, Paramo C, Obradovic S, Dieguez C, Casanueva FF. GH-releasing hormone and GH-releasing peptide-6 for diagnostic testing in GH-deficient adults. Lancet. 2000;356:1137.

    Article  CAS  PubMed  Google Scholar 

  • Porretti S, Giavoli C, Ronchi C, Lombardi G, Zaccaria M, Valle D, Arosio M, Beck-Peccoz P. Recombinant human GH replacement therapy and thyroid function in a large group of adult GH-deficient patients: when does L-T(4) therapy become mandatory? J Clin Endocrinol Metab. 2002;87:2042.

    Article  CAS  PubMed  Google Scholar 

  • Qu XD, Gaw GI, Al Sayed MY, Cohan P, Christenson PD, Swerdloff RS, Kelly DF, Wang C. Influence of body mass index and gender on growth hormone (GH) responses to GH-releasing hormone plus arginine and insulin tolerance tests. J Clin Endocrinol Metab. 2005;90:1563.

    Article  CAS  PubMed  Google Scholar 

  • Regal M, Paramo C, Sierra SM, Garcia-Mayor RV. Prevalence and incidence of hypopituitarism in an adult Caucasian population in northwestern Spain. Clin Endocrinol (Oxf). 2001;55:735.

    Article  CAS  Google Scholar 

  • Rosen T, Bengtsson BA. Premature mortality due to cardiovascular disease in hypopituitarism. Lancet. 1990;336:285.

    Article  CAS  PubMed  Google Scholar 

  • Rosen T, Eden S, Larson G, Wilhelmsen L, Bengtsson BA. Cardiovascular risk factors in adult patients with growth hormone deficiency. Acta Endocrinol (Copenh). 1993;129:195.

    CAS  Google Scholar 

  • Sartorio A, Ferrero S, Conti A, Bragato R, Malfatto G, Leonetti G, Faglia G. Adults with childhood-onset growth hormone deficiency: effects of growth hormone treatment on cardiac structure. J Intern Med. 1997;241:515.

    Article  CAS  PubMed  Google Scholar 

  • Sassolas G, Chazot FB, Jaquet P, Bachelot I, Chanson P, Rudelli CC, Tauber JP, Allannic H, Bringer J, Roudaut N, Rohmer V, Roger P, Latapie JL, Reville P, Leutenegger M. GH deficiency in adults: an epidemiological approach. Eur J Endocrinol. 1999;141:595.

    Article  CAS  PubMed  Google Scholar 

  • Schaefer S, Boegershausen N, Meyer S, Ivan D, Schepelmann K, Kann PH. Hypothalamic-pituitary insufficiency following infectious diseases of the central nervous system. Eur J Endocrinol. 2008;158:3.

    Article  CAS  PubMed  Google Scholar 

  • Schneider HJ, Herrmann BL, Schneider M, Sievers C, Schaaf L, Stalla GK. Discrepant results in the diagnosis of GH deficiency with the insulin-tolerance test and the GHRH plus arginine test in patients with traumatic brain injury. Eur J Endocrinol. 2006;155:553.

    Article  CAS  PubMed  Google Scholar 

  • Schneider HJ, Aimaretti G, Kreitschmann-Andermahr I, Stalla GK, Ghigo E. Hypopituitarism. Lancet. 2007a;369:1461.

    Article  CAS  PubMed  Google Scholar 

  • Schneider HJ, Kreitschmann-Andermahr I, Ghigo E, Stalla GK, Agha A. Hypothalamopituitary dysfunction following traumatic brain injury and aneurysmal subarachnoid hemorrhage: a systematic review. JAMA. 2007b;298:1429.

    Article  CAS  PubMed  Google Scholar 

  • Schneider HJ, Klotsche J, Wittchen HU, Stalla GK, Schopohl J, Kann PH, Kreitschmann-Andermahr I, Wallaschofski H. Effects of growth hormone replacement within the KIMS survey on estimated cardiovascular risk and predictors of risk reduction in patients with growth hormone deficiency. Clin Endocrinol (Oxf). 2011;75:825.

    Article  CAS  Google Scholar 

  • Sesmilo G, Biller BM, Llevadot J, Hayden D, Hanson G, Rifai N, Klibanski A. Effects of growth hormone administration on inflammatory and other cardiovascular risk markers in men with growth hormone deficiency. A randomized, controlled clinical trial. Ann Intern Med. 2000;133:111.

    Article  CAS  PubMed  Google Scholar 

  • Shalet SM, Shavrikova E, Cromer M, Child CJ, Keller E, Zapletalova J, Moshang T, Blum WF, Chipman JJ, Quigley CA, Attanasio AF. Effect of growth hormone (GH) treatment on bone in postpubertal GH-deficient patients: a 2-year randomized, controlled, dose-ranging study. J Clin Endocrinol Metab. 2003;88:4124.

    Article  CAS  PubMed  Google Scholar 

  • Sheehan HL. Postpartum necrosis of the anterior pituitary. J Pathol. 1937;45:189.

    Article  CAS  Google Scholar 

  • Sheehan HL. The frequency of post-partum hypopıtuıtarısm. J Obstet Gynaecol Br Commonw. 1965;72:103.

    Article  CAS  PubMed  Google Scholar 

  • Sherlock M, Ayuk J, Tomlinson JW, Toogood AA, Aragon-Alonso A, Sheppard MC, Bates AS, Stewart PM. Mortality in patients with pituitary disease. Endocr Rev. 2010;31:301.

    Article  PubMed  Google Scholar 

  • Simsek Y, Karaca Z, Tanriverdi F, Unluhizarci K, Selcuklu A, Kelestimur F. A comparison of low-dose ACTH, glucagon stimulation and insulin tolerance test in patients with pituitary disorders. Clin Endocrinol (Oxf). 2014;82:45.

    Google Scholar 

  • Stochholm K, Johannsson G. Reviewing the safety of GH replacement therapy in adults. Growth Horm IGF Res. 2015;25:149.

    Article  CAS  PubMed  Google Scholar 

  • Stochholm K, Gravholt CH, Laursen T, Jorgensen JO, Laurberg P, Andersen M, Kristensen LO, Feldt-Rasmussen U, Christiansen JS, Frydenberg M, Green A. Incidence of GH deficiency – a nationwide study. Eur J Endocrinol. 2006;155:61.

    Article  CAS  PubMed  Google Scholar 

  • Tanriverdi F, Kelestimur F. Pituitary dysfunction following traumatic brain injury: clinical perspectives. Neuropsychiatr Dis Treat. 2015;11:1835.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Tanriverdi F, Unluhizarci K, Kula M, Guven M, Bayram F, Kelestimur F. Effects of 18-month of growth hormone (GH) replacement therapy in patients with Sheehan’s syndrome. Growth Horm IGF Res. 2005;15:231.

    Article  CAS  PubMed  Google Scholar 

  • Tanriverdi F, Unluhizarci K, Coksevim B, Selcuklu A, Casanueva FF, Kelestimur F. Kickboxing sport as a new cause of traumatic brain injury-mediated hypopituitarism. Clin Endocrinol (Oxf). 2007;66:360.

    Article  Google Scholar 

  • Tanriverdi F, Taheri S, Ulutabanca H, Caglayan AO, Ozkul Y, Dundar M, Selcuklu A, Unluhizarci K, Casanueva FF, Kelestimur F. Apolipoprotein E3/E3 genotype decreases the risk of pituitary dysfunction after traumatic brain injury due to various causes: preliminary data. J Neurotrauma. 2008a;25:1071.

    Article  PubMed  Google Scholar 

  • Tanriverdi F, Ulutabanca H, Unluhizarci K, Selcuklu A, Casanueva FF, Kelestimur F. Three years prospective investigation of anterior pituitary function after traumatic brain injury: a pilot study. Clin Endocrinol. 2008b;68:573.

    Article  CAS  Google Scholar 

  • Tanriverdi F, Unluhizarci K, Kocyigit I, Tuna IS, Karaca Z, Durak AC, Selcuklu A, Casanueva FF, Kelestimur F. Brief communication: pituitary volume and function in competing and retired male boxers. Ann Intern Med. 2008c;148:827.

    Article  PubMed  Google Scholar 

  • Tanriverdi F, De Bellis A, Teksahin H, Alp E, Bizzarro A, Sinisi AA, Bellastella G, Paglionico VA, Bellastella A, Unluhizarci K, Doganay M, Kelestimur F. Prospective investigation of pituitary functions in patients with acute infectious meningitis: is acute meningitis induced pituitary dysfunction associated with autoimmunity? Pituitary. 2012;15:579.

    Article  CAS  PubMed  Google Scholar 

  • Tanriverdi F, De Bellis A, Ulutabanca H, Bizzarro A, Sinisi AA, Bellastella G, Amoresano PV, Dalla ML, Selcuklu A, Unluhizarci K, Casanueva FF, Kelestimur F. A five year prospective investigation of anterior pituitary function after traumatic brain injury: is hypopituitarism long-term after head trauma associated with autoimmunity? J Neurotrauma. 2013;30:1426.

    Article  PubMed  Google Scholar 

  • Tanriverdi F, Dokmetas HS, Kebapci N, Kilicli F, Atmaca H, Yarman S, Ertorer ME, Erturk E, Bayram F, Tugrul A, Culha C, Cakir M, Mert M, Aydin H, Taskale M, Ersoz N, Canturk Z, Anaforoglu I, Ozkaya M, Oruk G, Hekimsoy Z, Kelestimur F, Erbas T. Etiology of hypopituitarism in tertiary care institutions in Turkish population: analysis of 773 patients from Pituitary Study Group database. Endocrine. 2014a;47:198.

    Article  CAS  PubMed  Google Scholar 

  • Tanriverdi F, Karaca Z, Unluhizarci K, Kelestimur F. Unusual effects of GH deficiency in adults: a review about the effects of GH on skin, sleep, and coagulation. Endocrine. 2014b;47:679–89.

    Article  CAS  PubMed  Google Scholar 

  • Tanriverdi F, Schneider HJ, Aimaretti G, Masel BE, Casanueva FF, Kelestimur F. Pituitary dysfunction after traumatic brain injury: a clinical and pathophysiological approach. Endocr Rev. 2015;36:305.

    Article  CAS  PubMed  Google Scholar 

  • Theadom A, Starkey NJ, Dowell T, Hume PA, Kahan M, McPherson K, Feigin V. Sports-related brain injury in the general population: an epidemiological study. J Sci Med Sport. 2014;17:591.

    Article  PubMed  Google Scholar 

  • Toogood AA, Ryder WD, Beardwell CG, Shalet SM. The evolution of radiation-induced growth hormone deficiency in adults is determined by the baseline growth hormone status. Clin Endocrinol (Oxf). 1995;43:97.

    Article  CAS  Google Scholar 

  • Tsiakalos A, Xynos ID, Sipsas NV, Kaltsas G. Pituitary insufficiency after infectious meningitis: a prospective study. J Clin Endocrinol Metab. 2010;95:3277.

    Article  CAS  PubMed  Google Scholar 

  • van Bunderen CC, van den Dries CJ, Heymans MW, Franken AA, Koppeschaar HP, van der Lely AJ, Drent ML. Effect of long-term GH replacement therapy on cardiovascular outcomes in isolated GH deficiency compared with multiple pituitary hormone deficiencies: a sub-analysis from the Dutch National Registry of Growth Hormone Treatment in Adults. Eur J Endocrinol. 2014;171:151.

    Article  PubMed  CAS  Google Scholar 

  • Vance ML. Hypopituitarism. N Engl J Med. 1994;330:1651.

    Article  CAS  PubMed  Google Scholar 

  • Wilkinson CW, Pagulayan KF, Petrie EC, Mayer CL, Colasurdo EA, Shofer JB, Hart KL, Hoff D, Tarabochia MA, Peskind ER. High prevalence of chronic pituitary and target-organ hormone abnormalities after blast-related mild traumatic brain injury. Front Neurol. 2012;3:11.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wuster C, Abs R, Bengtsson BA, Bennmarker H, Feldt-Rasmussen U, Hernberg-Stahl E, Monson JP, Westberg B, Wilton P. The influence of growth hormone deficiency, growth hormone replacement therapy, and other aspects of hypopituitarism on fracture rate and bone mineral density. J Bone Miner Res. 2001;16:398.

    Article  CAS  PubMed  Google Scholar 

  • Zargar AH, Singh B, Laway BA, Masoodi SR, Wani AI, Bashir MI. Epidemiologic aspects of postpartum pituitary hypofunction (Sheehan’s syndrome). Fertil Steril. 2005;84:523.

    Article  PubMed  Google Scholar 

  • Zazryn TR, Finch CF, McCrory P. A 16 year study of injuries to professional kickboxers in the state of Victoria, Australia. Br J Sports Med. 2003;37:448.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Tanriverdi, F., Kelestimur, F. (2018). Physiopathology, Diagnosis, and Treatment of GH Deficiency. In: Casanueva, F., Ghigo, E. (eds) Hypothalamic-Pituitary Diseases. Endocrinology. Springer, Cham. https://doi.org/10.1007/978-3-319-38681-2_2-1

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