Abstract
Pharmacological treatment of growth hormone deficiency (GHD) in adults began in clinical practice more than 20 years ago. Since then, a great volume of experience has been accumulated on its effects on the symptoms and biochemical alterations that characterize this hormonal deficiency. The effects on body composition, muscle mass and strength, exercise capacity, glucose and lipid profile, bone metabolism, and quality of life have been fully demonstrated. The advance of knowledge has also taken place in the biological and molecular aspects of the action of this hormone in patients who have completed longitudinal growth. In recent years, several epidemiological studies have reported interesting information about the long-term effects of GH replacement therapy in regard to the possible induction of neoplasms and the potential development of diabetes. In addition, GH hormone receptor polymorphism could potentially influence GH therapy. Long-acting GH are under development to create a more convenient GH dosing profile, while retaining the excellent safety, efficacy, and tolerability of daily GH. In this article we compile the most recent data of GH replacement therapy in adults, as well as the molecular aspects that may condition a different sensitivity to this treatment.
Highlights
The syndrome of growth hormone deficiency (GHD) in adulthood has been fully defined [1,2] and is characterized by alterations in body composition, decreased capacity for exercise and quality of life (QoL), as well as a series of unfavorable changes in cardiovascular function, and lipid and carbohydrate metabolism
In patients with childhood-onset GHD it has been shown that the continuation or reinstitution of treatment for two years, in patients who completed growth, induced a significant increase in bone mineral density (BMD) compared to untreated patients [20]
A prospective study in 18 patients with GHD showed that seven years of GH treatment induced an increase in lumbar spine BMD, which stabilizes during long-term therapy
Summary
The syndrome of growth hormone deficiency (GHD) in adulthood has been fully defined [1,2] and is characterized by alterations in body composition, decreased capacity for exercise and quality of life (QoL), as well as a series of unfavorable changes in cardiovascular function, and lipid and carbohydrate metabolism. Expert consensus defines severe GHD as a GH response peak after insulin hypoglycemia below 3 μg/L. This is an arbitrary limit that depends on the assay method, the laboratory, and the type of stimulation. We review the most recent data and summarize our current knowledge about the benefits and risks of GH replacement therapy in adults deficient in this hormone. All articles related to replacement therapy of growth hormone deficiency were searched in MEDLINE from 1985 to 2017. The selection criteria included all prospective and retrospective studies, all case series, all case reports, and reviews concerning the effects of growth hormone replacement therapy on adult patients with GHD. This search was supplemented by a review of reference lists of potentially eligible studies and a manual search of key journals in the field of endocrinology
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