Skip to main content
SpringerLink
Log in

Diagnosis of Growth Hormone Deficiency in Adults

  • Chapter
  • First Online:
Growth Hormone Related Diseases and Therapy

Part of the book series: Contemporary Endocrinology ((COE))

  • 1017 Accesses

Abstract

Adult growth hormone deficiency (GHD) has a wide spectrum of clinical presentations including abnormal body composition, increased blood pressure, increased body weight, adverse lipid profiles, increased coagulability, and increased markers of inflammation, all associated with an increased cardiovascular morbidity and mortality. Detection of GHD is important, especially as successful GH replacement therapy improves the adult GHD syndrome and is accompanied by a significant increase in quality of life. Health authorities in many countries have approved the therapeutic use of GH in adult hypopituitary patients in whom GHD has been identified. The identification of adults with GHD remains challenging due to the episodic nature of GH secretion (pulsatile secretion) and multiple GH samples over 24 h are not practical as diagnostic procedure. For this reason in adults with known pituitary disease, diagnostic testing involves provocative tests of GH secretion. The insulin tolerance test (ITT) is regarded as the standard test of choice. Reproducibility, demanding surveillance during the test, and safety issues under some circumstances may be of some concern. Other more powerful provocative tests like the GH-releasing hormone (GHRH)  +  arginine and GHRH  +  GH-releasing hexapeptide 6 (GHRP-6) have gained acceptance after being evaluated in a large series of patients and controls. Glucagon test has yet to be evaluated in large series of patients and controls, but has already gained popularity particularly in the US after shortage of GHRH supplies. In adult patients with known pituitary disease, the presence and severity of GHD are related to the number of additional pituitary hormone deficits so that in panhypopituitary patients GH stimulation tests may be unnecessary. In that situation, insulin-like growth factor 1 (IGF-1) may be a useful diagnostic tool. Otherwise, considerable overlap exists for IGF-1 levels between normal subjects and those with GHD. Therefore, IGF-1 is not a reliable marker for diagnosis of GHD. When focused on childhood-onset GHD, these young adults who had previously received GH replacement in childhood need to be reevaluated for GH status.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 249.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Dattani M, Preece M. Growth hormone deficiency and related disorders: insights into causation and treatment. Lancet. 2004;363:1977–87.

    Article  PubMed  CAS  Google Scholar 

  2. Sassolas G, Borson Chazot F, Jaquet P, et al. GH deficiency in adults: an epidemiological approach. Eur J Endocrinol. 1999;141:595–600.

    Article  PubMed  CAS  Google Scholar 

  3. Abs R, Mattsson A, Bengtsson BA, et al. On behalf of the KIMS study group isolated growth hormone (GH) deficiency in adult patients: baseline clinical characteristics and responses to GH replacement in comparison with hypopituitary patients. Growth Horm IGF Res. 2005;15:349–59.

    Article  PubMed  CAS  Google Scholar 

  4. Ho KKY. 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;157:695–700.

    Article  PubMed  CAS  Google Scholar 

  5. Lisset CA, Thompson EGE, Rahim A, Brennan BMD, Shalet SM. How many tests are required to diagnose growth hormone (GH) deficiency in adults? Clin Endocrinol. 1999;51:551–7.

    Article  Google Scholar 

  6. Molitch M. Diagnosis of GH deficiency in adults-how good do the criteria need to be? J Clin Endocrinol Metab. 2002;87:473–6.

    Article  PubMed  CAS  Google Scholar 

  7. Abs R. Update on the diagnosis of GH deficiency in adults. Eur J Endocrinol. 2003;148:S3–8.

    Article  PubMed  CAS  Google Scholar 

  8. Ghigo E, Masel B, Aimaretti G, et al. Consensus guidelines on screening for hypopituitarism following traumatic brain injury. Brain Inj. 2005;19:711–24.

    Article  PubMed  CAS  Google Scholar 

  9. Doga M, Bonadonna S, Gola M, Mazziotti G, Giustina A. Growth hormone deficiency in the adult. Pituitary. 2006;9:305–11.

    Article  PubMed  CAS  Google Scholar 

  10. Molitch ME. Evaluation and treatment of adult growth hormone deficiency: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2006;91:1621–34.

    Article  PubMed  CAS  Google Scholar 

  11. Prabhakar VKB, Shalet SM. Aetiology, diagnosis, and management of hypopituitarism in adult life. Postgrad Med J. 2006;82:259–66.

    Article  PubMed  CAS  Google Scholar 

  12. Corneli G, Gasco V, Prodam F, Grottoli S, Aimaretti G, Ghigo E. Growth hormone levels in the diagnosis of growth hormone deficiency in adulthood. Pituitary. 2007;10:141–9.

    Article  PubMed  CAS  Google Scholar 

  13. Kaushal K, Shalet SM. Defining growth hormone status in adults with hypopituitarism. Horm Res. 2007;68:185–94.

    Article  PubMed  CAS  Google Scholar 

  14. Gasco V, Corneli G, Rovere S, et al. Diagnosis of adult GH deficiency. Pituitary. 2008;11:121–8.

    Article  PubMed  CAS  Google Scholar 

  15. Ghigo E, Aimaretti G, Corneli G. Diagnosis of adult GH deficiency. Growth Horm IGF Res. 2008;18:1–16.

    Article  PubMed  CAS  Google Scholar 

  16. Casanueva FF, Catro AI, Micic D, Kelestimur F, Dieguez C. New guidelines for the diagnosis of growth hormone deficiency in adults. Horm Res. 2009;71 Suppl 1:112–5.

    Article  PubMed  CAS  Google Scholar 

  17. Ho KY. Growth hormone deficiency in adults. In: DeGroot LJ, Jameson JL, editors. Endocrinology. Philadelphia: Elsevier; 2006. p. 755–65.

    Google Scholar 

  18. Schneider HJ, Aimaretti G, Kreitschmann-Andermahr I, Stalla GK, Ghigo E. Hypopituitarism. Lancet. 2007;369:1461–70.

    Article  PubMed  CAS  Google Scholar 

  19. Growth Hormone Research Society. Consensus guidelines for the diagnosis and treatment of adults with growth hormone deficiency. J Clin Endocrinol Metab. 1998;83:379–81.

    Article  Google Scholar 

  20. Toogood A, Beardwell C, Shalet S. The severity of growth hormone deficiency in adults with pitutiary disease is related to the degree of hypopituitarism. Clin Endocrinol. 1994;41:511–6.

    Article  CAS  Google Scholar 

  21. Hartman M, Crowe B, Biller B, Ho K, Clemmons D, Chipman J; On behalf of the HypoCCS Advisory Board and the US HypoCCS Study Group. Which patients do not require a GH stimulation test for the diagnosis of GH deficiency? J Clin Endocrinol Metab. 2002;87:477–85.

    Article  Google Scholar 

  22. Kelly DF, Gonzalo IT, Cohan P, et al. Hypopituitarism following traumatic brain injury and aneurysmal subarachnoid hemorrhage: a preliminary report. J Neurosurg. 2000;93:743–52.

    Article  PubMed  CAS  Google Scholar 

  23. Benvenga S, Campenni A, Ruggeri RM, Trimarchi F. Hypopituitarism secondary to head trauma. J Clin Endocrinol Metab. 2000;85:1353–61.

    Article  PubMed  CAS  Google Scholar 

  24. Lieberman SA, Oberoi AL, Gilkison CR, et al. Prevalence of neuroendocrine dysfunction in patients recovering from traumatic brain injury. J Clin Endocrinol Metab. 2001;86:2752–6.

    Article  PubMed  CAS  Google Scholar 

  25. Aimaretti G, Ambrosio MR, Di Somma C, et al. Traumatic brain injury and subarachnoid haemorrhage are conditions at high risk for hypopituitarism: screening study at 3 months after the brain injury. Clin Endocrinol. 2004;61:320–6.

    Article  CAS  Google Scholar 

  26. Popovic V, Pekic S, Pavlovic D, et al. Hypopituitarism as a consequence of traumatic brain injury (TBI) and its possible relation with cognitive and mental distress. J Endocrinol Invest. 2004;27:1048–54.

    PubMed  CAS  Google Scholar 

  27. Popovic V. GH deficiency as the most common pituitary defect after TBI: clinical implications. Pituitary. 2005;8:239–43.

    Article  PubMed  Google Scholar 

  28. Dattani MT, Hindmarsh PC. Growth hormone deficiency in children. In: DeGroot LJ, Jameson JL, editors. Endocrinology. Philadelphia: Elsevier; 2006. p. 733–54.

    Google Scholar 

  29. Aimaretti G, Baffoni C, DiVito L, et al. Comparison among old and new provocative tests of GH secretion in 178 normal adults. Eur J Endocrinol. 2000;142:347–52.

    Article  PubMed  CAS  Google Scholar 

  30. Biller BMK, Samuels MH, Zagar A, et al. Sensitivity and specificity of six tests for the diagnosis of adult GH deficiency. J Clin Endocrinol Metab. 2002;87:2067–79.

    Article  PubMed  CAS  Google Scholar 

  31. Yuen KC, Biller BM, Molitch ME, Cook DM. Is lack of recombinant growth hormone (GH)-releasing hormone in the United States a setback or time to consider glucagon testing for adult GH deficiency? J Clin Endocrinol Metab. 2009;94:2702–7.

    Article  PubMed  CAS  Google Scholar 

  32. Shalet SM, Toogood A, Rahim A, Brennan BM. The diagnosis of growth hormone deficiency in children and adults. Endocr Rev. 1998;19:203–23.

    Article  PubMed  CAS  Google Scholar 

  33. Hoeck H, Vestergaard P, Jakobsen PE, Falhof J, Laurberg P. Diagnosis of growth hormone (GH) deficiency in adults with hypothalamic-pituitary disorders: comparison of test results using pyridostigmine plus GH-releasing hormone (GHRH), clonidine plus GHRH, and insulin-induced hypoglycemia as GH secretagogues. J Clin Endocrinol Metab. 2000;85:1467–72.

    Article  PubMed  CAS  Google Scholar 

  34. Bidlingmaier M, Freda PU. Measurement of human growth hormone by immunoassays: current status, unsulved problems and clinical consequences. Growth Horm IGF Res. 2009. doi:10.1016/j.ghir.2009.09.005.

  35. Iranmanesh A, Lizzarralde G, Veldhuis JD. Age and relative adiposity are specific negative determinants of the frequency and amplitude of growth hormone (GH) secretory bursts and the half-life of endogenous GH in healthy men. J Clin Endocrinol Metab. 1991;73:1081–8.

    Article  PubMed  CAS  Google Scholar 

  36. Hoffman DM, O’Sullivan AJ, Baxter RC, Ho KK. Diagnosis of growth hormone deficiency in adults. Lancet. 1994;343:1064–8.

    Article  PubMed  CAS  Google Scholar 

  37. Darzy KH, Thorner MO, Shalet SM. Cranially irradiated adult cancer survivors may have normal spontaneous GH secretion in the presence of discordant peak GH responses to stimulation tests (compensated GH deficiency). Clin Endocrinol. 2009;70:287–93.

    Article  CAS  Google Scholar 

  38. Darzy KH, Shalet SM. Hypopituitarism following radiotherapy. Pituitary. 2009;12:40–50.

    Article  PubMed  Google Scholar 

  39. Lee P, Greenfield JR, Ho KKY. Factors determining inadequate hypoglycaemia during insulin tolerance testing (ITT) after pituitary surgery. Clin Endocrinol. 2009;71:82–5.

    Article  CAS  Google Scholar 

  40. Pfeifer M, Kanc K, Verhovec R, Kocijancic A. Reproducibility of the insulin tolerance test (ITT) for assessment of growth hormone and cortisol secretion in normal and hypopituitary adult men. Clin Endocrinol. 2001;54:17–22.

    Article  CAS  Google Scholar 

  41. Cordido F, Alvarez-Castro P, Isidro ML, Casanueva FF, Dieguez C. Comparison between insulin tolerance test, growth hormone (GH)-releasing hormone (GHRH), GHRH plus acipimox and GHRH plus GH-releasing peptide-6 for the diagnosis of adults GH deficiency in normal subjects, obese and hypopituitary patients. Eur J Endocrinol. 2003;149:117–22.

    Article  PubMed  CAS  Google Scholar 

  42. Aimaretii G, Corneli G, Razzore P, et al. Comparison between insulin-induced hypoglycaemia and growth hormone (GH)-releasing hormone  +  arginine as provocative tests for the diagnosis of GH deficiency in adults. J Clin Endocrinol Metab. 1998;83:1615–8.

    Article  Google Scholar 

  43. Ghigo E, Aimaretti G, Arvat E, Camanni F. Growth hormone-releasing hormone combined with arginine or growth hormone secretagogues for the diagnosis of growth hormone deficiency in adults. Endocrine. 2001;15:29–38.

    Article  PubMed  CAS  Google Scholar 

  44. Ghigo E, Aimaretti G, Gianotti L, Bellone J, Arvat E, Cammani F. New approach to the diagnosis of growth hormone deficiency in adults. Eur J Endocrinol. 1996;134:352–6.

    Article  PubMed  CAS  Google Scholar 

  45. Casanueva FF. Physiology of growth hormone secretion and action. In: Melmed S, editor. Endocrinology and metabolism clinics of North America, vol. 21. Philadelphia: W.B. Saunders; 1992. p. 483–517.

    Google Scholar 

  46. Ghigo E, Miola C, Aimaretti G, et al. Arginine abolishes the inhibitory effect of glucose on the GH response to GHRH in man. Metabolism. 1992;41:1000–3.

    Article  PubMed  CAS  Google Scholar 

  47. Corneli G, Di Somma C, Baldelli R, et al. The cut-off limits of the GH response to GH-releasing hormone-arginine test related to body mass index. Eur J Endocrinol. 2005;153:257–64.

    Article  PubMed  CAS  Google Scholar 

  48. Darzy KH, Aimaretti G, Wieringa G, Gattamaneni HR, Ghigo E, Shalet SM. The usefulness of the combined growth hormone (GH)-releasing hormone and arginine stimulation test in the diagnosis of radiation-induced GH deficiency is dependent on the post-irradiation time interval. J Clin Endocrinol Metab. 2003;88:95–102.

    Article  PubMed  CAS  Google Scholar 

  49. Gomez JM, Espadero RM, Escobar-Jimenez F, et al. Growth hormone release after glucagon as a reliable test of growth hormone assessment in adults. Clin Endocrinol. 2002;56:329–34.

    Article  CAS  Google Scholar 

  50. Micmacher E, Assumpcao RP, Redorat R, et al. Growth hormone secretion in response to glucagon stimulation test in healthy middle-aged men. Arq Bras Endocrinol Metabol. 2009;53:853–8.

    Article  PubMed  Google Scholar 

  51. Secco A, di Iorgi N, Napoli F, et al. The glucagon test in the diagnosis of growth hormone deficiency in children with short stature younger than 6 years. J Clin Endocrinol Metab. 2009;94:4251–7.

    Article  PubMed  CAS  Google Scholar 

  52. Bowers CY. GH releasing peptides-structure and kinetics. J Pediatr Endocrinol. 1993;6:21–31.

    Article  PubMed  CAS  Google Scholar 

  53. Bowers CY. Synergistic release of growth hormone by GHRP and GHRH: scope and implication. In: Bercu BB, Walker RF, editors. Growth hormone secretagoguges in clinical practice. New York: Marcel Dekker; 1998. p. 1–25.

    Google Scholar 

  54. Frieboes RM, Murck H, maier P, Schier T, Holsboer F, Steiger A. Growth hormone-releasing peptide-6 stimulates sleep, growth hormone, ACTH and cortisol release in normal man. Neuroendocrinology. 1995;61:584–9.

    Article  PubMed  CAS  Google Scholar 

  55. Kojima M, Hosoda H, Date Y, Nakazoto M, Matsuo H, Kangawa K. Ghrelin is a growth hormone-releasing acylated peptide from stomach. Nature. 1999;402:656–60.

    Article  PubMed  CAS  Google Scholar 

  56. Popovic V, Leal A, Micic D, et al. GH-releasing hormone and GH-releasing peptide-6 for diagnostic testing in GH-deficient adults. Lancet. 2000;356:1137–42.

    Article  PubMed  CAS  Google Scholar 

  57. Mahajan T, Lightman SL. A simple test for growth hormone deficiency in adults. J Clin Endocrinol Metab. 2000;85:1473–6.

    Article  PubMed  CAS  Google Scholar 

  58. Popovic V, Pekic S, Micic D, et al. Evaluation of the reproducibility of the GHRH plus GHRP-6 test of growth hormone reserve in adults. Clin Endocrinol. 2004;60:185–91.

    Article  CAS  Google Scholar 

  59. Popovic V, Damjanovic S, Micic D, Djurovic M, Dieguez C, Casanueva FF. Blocked growth hormone-releasing peptide (GHRP-6)-induced GH secretion and absence of the synergic action of GHRP-6 plus GH-releasing hormone in patients with hypothalamic-pituitary disconnection: evidence that GHRP-6 main action is exerted at the hypothalamic level. J Clin Endocrinol Metab. 1995;80:942–7.

    Article  PubMed  CAS  Google Scholar 

  60. Micic D, Popovic V, Doknic M, Macut D, Dieguez C, Casanueva FF. Preserved growth hormone (GH) secretion in aged and very old subjects after testing with the combined stimulus GH-releasing hormone plus GH-releasing hexapeptide-6. J Clin Endocrinol Metab. 1998;83:2569–72.

    Article  PubMed  CAS  Google Scholar 

  61. Kelestimur F, Popovic V, Leal A, et al. Effect of obesity and morbid obesity on the growth hormone (GH) secretion elicited by the combined GHRH  +  GHRP-6 test. Clin Endocrinol. 2006;64:667–71.

    Article  CAS  Google Scholar 

  62. Popovic V, Pekic S, Simic M, et al. Physical activity or food intake prior to testing did not affect the reproducibility of GH secretion elicited by GH releasing hormone plus GH-releasing hexapeptide in normal adult subjects. Clin Endocrinol. 2002;56:89–94.

    Article  CAS  Google Scholar 

  63. Leal A, Lage M, Popovic V, et al. A single growth hormone (GH) determination is sufficient for the diagnosis of GH-deficiency in adult patients using the growth hormone releasing hormone plus growth hormone releasing peptide-6 test. Clin Endocrinol. 2002;57:377–84.

    Article  CAS  Google Scholar 

  64. Pekic S, Doknic M, Djurovic M, et al. The influence of serum cortisol levels on growth hormone (GH) responsiveness to GH-releasing hormone plus GH-releasing peptide-6 in patients with hypocortisolism. Hormones. 2003;4:243–9.

    Google Scholar 

  65. Ho K. Commentary: diagnosis of adult GH deficiency. Lancet. 2000;356:1125–6.

    Article  PubMed  CAS  Google Scholar 

  66. Popovic V, Pekic S, Doknic M, et al. The effectiveness of arginine  +  GHRH test compared with GHRH  +  GHRP-6 test in diagnosing growth hormone deficiency in adults. Clin Endocrinol. 2003;59:251–7.

    Article  CAS  Google Scholar 

  67. Popovic V, Pekic S, Golubicic I, Doknic M, Dieguez C, Casanueva F. The impact of cranial irradiation on growth hormone responsiveness to GH-releasing hormone plus GH-releasing peptide-6. J Clin Endocrinol Metab. 2002;87:2095–9.

    Article  PubMed  CAS  Google Scholar 

  68. Arvat E, Maccario M, DiVito L, et al. Endocrine activities of ghrelin, a natural growth hormone secretagogue (GHS), in humans: comparison and interactions with hexarelin, a nonnatural peptidyl GHS, and GH-releasing hormone. J Clin Endocrinol Metab. 2001;86:1169–74.

    Article  PubMed  CAS  Google Scholar 

  69. Aimaretti G, Baffoni C, Broglio F, et al. Endocrine responses to ghrelin in adult patients with isolated childhood-onset growth hormone deficiency. Clin Endocrinol. 2002;56:765–71.

    Article  CAS  Google Scholar 

  70. Maghnie M, Pennati MC, Civardi E, et al. GH response to ghrelin in subjects with congenital GH deficiency: evidence that ghrelin action requires hypothalamic-pituitary connections. Eur J Endocrinol. 2007;156:449–54.

    Article  PubMed  CAS  Google Scholar 

  71. Tiulpakov AN, Brook CG, Pringle PJ, Peterkova VA, Volevodz NN, Bowers CY. GH responses to intravenous bolus infusions of GH releasing hormone and GH releasing peptide 2 separately and in combination in adult volunteers. Clin Endocrinol. 1995;43:347–50.

    Article  CAS  Google Scholar 

  72. Chihara K, Shimatsu A, Hizuka N, Tanaka T, Seino Y, Kato Y; for the KP-102 Study Group. A simple diagnostic test using GH-releasing peptide-2 in adult GH deficiency. Eur J Endocrinol. 2007;157:19–27.

    Article  Google Scholar 

  73. Alaioubi B, Mann K, Petersenn S. Diagnosis of growth hormone deficiency in adults: provocatine testing with GHRP-6 in comparison to the insulin tolerance test. Horm Metab Res. 2009;41:238–43.

    Article  PubMed  CAS  Google Scholar 

  74. Maghnie M, Spica-Russotto V, Cappa M, et al. The growth hormone response to hexarelin in patients with different hypothalamic-pituitary abnormalities. J Clin Endocrinol Metab. 1998;83:3886–9.

    Article  PubMed  CAS  Google Scholar 

  75. Chapman IM, Pescovitz OH, Murphy G, et al. Oral administration of growth hormone (GH) releasing peptide-mimetic MK-677 stimulates the GH/insulin-like growth factor-I axis in selected GH-deficient adults. J Clin Endocrinol Metab. 1997;82:3455–63.

    Article  PubMed  CAS  Google Scholar 

  76. Gil-Ad I, Topper E, Laaron Z. Oral clonidine as a growth hormone stimulation test. Lancet. 1979;11:278–9.

    Article  Google Scholar 

  77. Gibney J, Healy M, Smith TP, McKenna TJ. A simple and cost-effective approach to assessment of pituitary adrenocorticotropin and growth hormone reserve: combined use of the overnight metyrapone test and insulin-like growth factor-I standard deviation scores. J Clin Endocrinol Metab. 2008;93:3763–8.

    Article  PubMed  CAS  Google Scholar 

  78. Secco A, di Iorgi N, Napoli F, et al. Reassessment of the growth hormone status in young adults with childhood-onset growth hormone deficiency: reappraisal of insulin tolerance test. J Clin Endocrinol Metab. 2009;94:4195–204.

    Article  PubMed  CAS  Google Scholar 

  79. Radetti G, di Iorgi N, Paganini C, et al. The advantage of measuring spontaneous growth hormone (GH) secretion compared with the insulin tolerance test in the diagnosis of GH deficiency in young adults. Clin Endocrinol. 2007;67:78–84.

    Article  CAS  Google Scholar 

  80. Bates AS, Evans AJ, Jones P, Clayton RN. Assessment of GH status in adults with GH deficiency using serum growth hormone, serum insulin-like growth factor-I and urinary growth hormone excretion. Clin Endocrinol. 1995;42:425–30.

    Article  CAS  Google Scholar 

  81. Mukherjee A, Shalet SM. The value of IGF1 estimation in adults with GH deficiency. Eur J Endocrinol. 2009;161:S33–9.

    Article  PubMed  CAS  Google Scholar 

  82. Brabant G, von zur Muhlen A, Wuster C, et al. Serum insulin-like growth factor I reference values for an automated chemiluminescence immunoassay system: results from a multicenter study. Horm Res. 2003;60:53–60.

    Article  PubMed  CAS  Google Scholar 

  83. Attanasio AF, Lamberts SW, Matranga AM, et al. 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;82:82–8.

    Article  PubMed  CAS  Google Scholar 

  84. Lissett CA, Jonsson P, Monson JP, Shalet SM. Determinants of IGF-I status in a large cohort of growth hormone-deficient (GHD) subjects: the role of timing of onset of GHD. Clin Endocrinol. 2003;59:773–8.

    Article  CAS  Google Scholar 

  85. Savage MO, Drake WM, Carroll PV, Monson JP. Transitional care of GH deficiency: when to stop GH therapy. Eur J Endocrinol. 2004;151:S61–5.

    Article  PubMed  CAS  Google Scholar 

  86. 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;152:165–70.

    Article  PubMed  CAS  Google Scholar 

  87. Maghnie M, Strigazzi C, Tinelli C, et al. Growth hormone (GH) deficiency (GHD) of childhood onset: reassessment of GH status and evaluation of the predictive criteria for permanent GHD in young adults. J Clin Endocrinol Metab. 1999;84:1324–8.

    Article  PubMed  CAS  Google Scholar 

  88. Attanasio AF, Howell S, Bates PC, et al. Confirmation of severe GH deficiency after final heigh in patients diagnosed as GH deficient during childhood. Clin Endocrinol. 2002;56:503–7.

    Article  CAS  Google Scholar 

  89. Bonfig W, Bechtold S, Bachmann S, et al. Reassessment of the optimal growth hormone cut-off level in insulin tolerance testing for growth hormone secretion in patients with childhood-onset growth hormone deficiency during transition to adulthood. J Pediatr Endocrinol Metab. 2008;21:1049–56.

    Article  PubMed  CAS  Google Scholar 

  90. Gasco V, Corneli G, Beccuti G, et al. Retesting the childhood-onset GH-deficient patient. Eur J Endocrinol. 2008;159:S45–52.

    Article  PubMed  CAS  Google Scholar 

  91. Maghnie M, Aimaretti G, Bellone S, et al. Diagnosis of GH deficiency in the transition period: accuracy of insulin tolerance test and insulin-like growth factor-I measurement. Eur J Endocrinol. 2005;152:589–96.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Neuroendocrine Unit, Institute of Endocrinology, University Clinical Center, Belgrade, Serbia

    Sandra Pekic

  2. Neuroendocrine Unit, Institute of Endocrinology, University Clinical Center, Dr Subotic 13, 11000, Belgrade, Serbia

    Vera Popovic

Authors
  1. Sandra Pekic
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vera Popovic
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Vera Popovic .

Editor information

Editors and Affiliations

  1. Princess Alexandra Hospital &, The University of Queensland, Centres for Health Research, Ipswich Road Woolloongabba 199, Brisbane, 4102, Queensland, Australia

    Ken Ho

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Pekic, S., Popovic, V. (2011). Diagnosis of Growth Hormone Deficiency in Adults. In: Ho, K. (eds) Growth Hormone Related Diseases and Therapy. Contemporary Endocrinology. Humana Press. https://doi.org/10.1007/978-1-60761-317-6_9

Download citation

  • DOI: https://doi.org/10.1007/978-1-60761-317-6_9

  • Published:

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-60761-316-9

  • Online ISBN: 978-1-60761-317-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation