Abstract
Growth hormone (GH) deficiency (GHD) in adults is well-characterized and includes abnormal body composition, reduced bone mass, an adverse cardiovascular risk profile, and impaired quality of life. In the early 1990s, it was also shown that patients with hypopituitarism without GH replacement therapy (GHRT) had excess mortality. Today, GHRT has been shown to decrease or reverse the negative effects of GHD. In addition, recent papers have shown that mortality and morbidity are approaching normal in hypopituitary patients with GHD who receive modern endocrine therapy including GHRT. Since the first dose-finding studies, it has been clear that efficacy and side effects differ substantially between patients. Many factors have been suggested as affecting responsiveness, such as sex, age, age at GHD onset, adherence, and GH receptor polymorphisms, with sex and sex steroid replacement having the greatest impact. Therefore, the individual tailoring of GH dose is of great importance to achieve sufficient efficacy without side effects. One group that stands out is women receiving oral estrogen replacement, who needs the highest dose. Serum insulin-like growth factor-1 (IGF-1) is still the most used biochemical biomarker for GH dose titration, although the best serum IGF-1 target is still debated. Patients with GHD due to acromegaly, Cushing's disease, or craniopharyngioma experience similar effects from GHRT as others. Arch Endocrinol Metab. 2019;63(6):592-600.
Highlights
Growth hormone (GH) deficiency (GHD) has been a well-known clinical entity for a long time in children
The aim of this review is to describe the individual variability in response to GH replacement therapy (GHRT) and, the importance of individualization of the treatment
One theory as to why GHRT is beneficial with respect to cardiovascular disease is that a high-normal insulin-like growth factor-1 (IGF-1) target level demonstrates a reduction of waist circumference, which contributes to improvement of vascular function through regulation of sympathetic nervous system activity in the microcirculation in a recent unpublished trial
Summary
Growth hormone (GH) deficiency (GHD) has been a well-known clinical entity for a long time in children. The main features of adult GHD include abnormal body composition, reduced muscle strength and exercise capacity, reduced bone mass, an adverse cardiovascular risk profile, and impaired quality of life. Since the first two double-blind, placebo-controlled studies of GHRT in adults were reported in 1989, daily GHRT has been shown to reverse or ameliorate many of the symptoms associated with adult GHD [8,9]. A metaanalysis of randomized, blinded, placebo-controlled trials showed that long-term GHRT has beneficial effects on muscle and fat mass, lipid profile, and diastolic blood pressure [10]. Personalized approach to GHRT in adults and mortality are close to normal in hypopituitary patients with GHD receiving modern replacement therapy, including GHRT and if needed personalized substitution of other pituitary axes [13,14]. The aim of this review is to describe the individual variability in response to GHRT and, the importance of individualization of the treatment
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