Growth Hormone Deficiency Clinical Presentation

  • Author: Mohsen S Eledrisi, MD, FACP, FACE; Chief Editor: George T Griffing, MD   more...
 
Updated: Dec 2, 2011
 

History

Children

  • Growth failure after a period of normal growth is a characteristic feature of GHD that presents during childhood. Children present with short stature and low growth velocity for age and pubertal stage.[12]
  • Consider the possibility of hypopituitarism in patients with neonatal hypoglycemia, prolonged jaundice, septo-optic dysplasia, midline facial defects (eg, cleft palate, solitary central incisor), male micropenis (not necessarily related to gonadotropin deficiency), histiocytosis X, previous cranial irradiation, and symptoms of a mass lesion in the hypothalamic-pituitary region (eg, headaches, visual disturbances).

Adults[13]

  • Adults with GHD usually have a history of pituitary tumors that may have been treated with surgery or radiation, or they may have previously suffered a head trauma.
  • Some patients will also have manifestations of deficiency of other pituitary hormones, such as thyroid, adrenal, and gonadal hormones
  • The symptoms of GHD in adults are often nonspecific. Reported symptoms may include low energy level, decreased strength and exercise tolerance, increased weight or difficulty losing weight, emotional lability, anxiety, social isolation, decreased libido, and impaired sleep. Some persons with GHD are entirely asymptomatic.[7]
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Physical

Children

  • The standing height standard deviation score is usually below -2.
  • Growth velocity is below the 10-25th percentile, which reflects growth deceleration.
  • Increased subcutaneous fat is present, especially around the trunk.
  • The face is immature, with a prominent forehead and depressed midfacial development.
  • Dentition is delayed.
  • The average age of pubertal onset is delayed in males and females.
  • In males, the phallus may be small.

Adults

  • Reduced lean body mass and increased weight, with body fat mass predominantly in the abdominal region
  • Thin and dry skin
  • Cool peripheries
  • Poor venous access
  • Reduced muscle mass and strength and reduced exercise performance
  • Depressed affect
  • Labile emotions
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Causes

Causes of GHD in children can be divided into 3 categories.

  • Congenital conditions
    • Defective pituitary development that leads to pituitary aplasia
    • Empty sella
    • Encephalocele
    • Midline defects
    • Septo-optic dysplasia
    • Panhypopituitarism
    • Genetic abnormalities, including autosomal-recessive, autosomal-dominant, or X-linked defects or a mutation or deletion in the growth hormone gene or in the GHRH.
  • Acquired conditions
    • Tumors of the hypothalamic-pituitary region - Craniopharyngioma is the most common tumor.
    • Cranial irradiation
    • Infiltrative diseases, including sarcoidosis, tuberculosis, histiocytosis X, hemochromatosis, and lymphocytic hypophysitis
    • Trauma
    • Hypoxic insult
  • Idiopathic - In many cases, no clear etiology can be identified.

Causes of GHD in adults

  • Pituitary disease - More than 90% of patients have pituitary disease, which is usually caused by a pituitary tumor, by surgery, or by radiation therapy for the tumor.
  • Other causes - These include trauma, tuberculosis, histiocytosis X, hemochromatosis, lymphocytic hypophysitis, and infiltrative diseases, such as sarcoidosis.
  • Idiopathic - In rare instances, no cause can be found.
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Contributor Information and Disclosures
Author

Mohsen S Eledrisi, MD, FACP, FACE  Consultant, Department of Internal Medicine, Division of Endocrinology and Metabolism, King Abdulaziz National Guard Medical Center, Saudi Arabia

Mohsen S Eledrisi, MD, FACP, FACE is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians-American Society of Internal Medicine, American Diabetes Association, American Medical Association, and Endocrine Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Steven R Gambert, MD  Professor of Medicine, Johns Hopkins University School of Medicine; Director of Geriatric Medicine, University of Maryland Medical Center and R. Adams Cowley Shock Trauma Center

Steven R Gambert, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physician Executives, American College of Physicians, American Geriatrics Society, Association of Professors of Medicine, Endocrine Society, and Gerontological Society of America

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Don S Schalch, MD  Professor Emeritus, Department of Internal Medicine, Division of Endocrinology, University of Wisconsin Hospitals and Clinics

Don S Schalch, MD is a member of the following medical societies: American Diabetes Association, American Federation for Medical Research, Central Society for Clinical Research, and Endocrine Society

Disclosure: Nothing to disclose.

Mark Cooper, MBBS, PhD, FRACP  Head, Diabetes & Metabolism Division, Baker Heart Research Institute, Professor of Medicine, Monash University

Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD  Professor of Medicine, St Louis University School of Medicine

George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Additional Contributors

Ali A Al-Qarni, MD, Consulting Endocrinologist, King Abdulaziz National Guard Hospital, Saudi Arabia, contributed to this article.

References

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