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A Pragmatic Clinical and Pathophysiological Approach to Growth Hormone Replacement in the Adult Patient

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Pituitary Disorders throughout the Life Cycle

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Abstract

Adult growth hormone deficiency (GHD) is a well-defined clinical entity characterized by abnormal body composition, reduced muscle strength and exercise capacity, reduced bone mass, an adverse cardiovascular risk profile, and impaired quality of life. Excess mortality has been reported in adults with hypopituitarism, including GHD, replaced for all other hormonal deficiencies except GHD implying a possible, yet unproven, contributing role of GHD. This condition may occur during childhood that remains persistent into adulthood or develops during adulthood. Recent studies have consistently shown that recombinant human GH (rhGH) therapy reverses most of the negative effects of GHD. Furthermore, the benefits of rhGH replacement therapy in young patients transitioning from pediatric to adult-care services and the safety and efficacy of long-term rhGH replacement have been reinforced with accumulation of clinical experience and current published data. Nonetheless, there is still a misconception regarding the difference between “organic” adult GHD versus the physiological decline of endogenous GH secretion due to aging and the continued misuse of rhGH for sporting enhancement and anti-aging purposes. Therefore, diagnosing adult GHD should first carefully consider the type of patient to be tested coupled with an intention to treat and which GH stimulation test to use, including adopting appropriate GH cut-point levels. In this chapter, two different yet commonly encountered case scenarios are presented, and practical recommendations on assessment, screening, diagnostic testing, treatment considerations, rhGH dosing regimens, and treatment monitoring schedules are provided based on the pathophysiology of the GHD.

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Disclosure Statement

KCJY has received research grants to Barrow Neurological Institute for clinical research studies from Pfizer, Novo Nordisk, OPKO Biologics, Versartis, and Aeterna Zentaris and served on Advisory Boards for Pfizer, Novo Nordisk, Ipsen, and Strongbridge.

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Authors and Affiliations

  1. Barrow Pituitary Center, Barrow Neurological Institute, University of Arizona College of Medicine and Creighton School of Medicine, Phoenix, AZ, USA

    Kevin C. J. Yuen

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  1. Kevin C. J. Yuen
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Correspondence to Kevin C. J. Yuen .

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  1. Mayo Clinic, Jacksonville, FL, USA

    Susan L. Samson

  2. Emory University School of Medicine, Atlanta, GA, USA

    Adriana G. Ioachimescu

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Yuen, K.C.J. (2022). A Pragmatic Clinical and Pathophysiological Approach to Growth Hormone Replacement in the Adult Patient. In: Samson, S.L., Ioachimescu, A.G. (eds) Pituitary Disorders throughout the Life Cycle. Springer, Cham. https://doi.org/10.1007/978-3-030-99918-6_19

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  • DOI: https://doi.org/10.1007/978-3-030-99918-6_19

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