Growth Hormone Deficiency Follow-up

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

Further Outpatient Care

  • Close follow-up care with an endocrinologist is recommended.
  • In children, the response to treatment is evaluated by assessing height, weight, and growth velocity.
  • In adults, change in body composition, exercise capacity, skeletal integrity, lipids, and quality of life are monitored.[4, 5] The suggested favorable effect of growth hormone treatment on vascular mortality in patients with hypopituitarism remains to be proven.
  • There is no consensus on the duration of growth hormone treatment. Growth hormone should be continued until growth ceases, after which it is recommended to retest the growth hormone axis by stimulation tests.[17, 18] Some patients, particularly those with idiopathic growth hormone deficiency, may have a normal response and not require a continuation of therapy. Children who have multiple pituitary hormone deficiencies rarely recover and require continuation of treatment into adulthood.
  • Growth hormone therapy can be continued for adults if benefits are observed. If no objective benefits are seen after 1 year of treatment, discontinuation of growth hormone therapy should be considered.
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Complications

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Prognosis

  • Prognosis is determined by response to growth hormone replacement therapy and is generally favorable.
  • Growth hormone treatment is meant to be a replacement therapy and can be expected only to make short children grow at a normal rate.
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Patient Education

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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

  1. 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. Jan 1997;82(1):82-8. [Medline]. [Full Text].

  2. Hyldstrup L, Conway GS, Racz K, Keller A, Chanson P, Zacharin M, et al. Growth hormone effects on cortical bone dimensions in young adults with childhood-onset growth hormone deficiency. Osteoporos Int. Nov 29 2011;[Medline].

  3. Webb EA, O'Reilly MA, Clayden JD, Seunarine KK, Chong WK, Dale N, et al. Effect of growth hormone deficiency on brain structure, motor function and cognition. Brain. Nov 26 2011;[Medline].

  4. Molitch ME, Clemmons DR, Malozowski S, et al. Evaluation and treatment of adult growth hormone deficiency: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. May 2006;91(5):1621-34. [Medline]. [Full Text].

  5. Bengtsson BA, Eden S, Lonn L. Treatment of adults with growth hormone (GH) deficiency with recombinant human GH. J Clin Endocrinol Metab. 1993;76(2):309-17. [Medline]. [Full Text].

  6. Elbornsson M, Götherström G, Franco C, Bengtsson BA, Johannsson G, Svensson J. Effects of 3-year growth hormone (GH) replacement therapy on bonemineral density in younger and elderly adults with adult onset GH deficiency. Eur J Endocrinol. Nov 21 2011;[Medline].

  7. Carroll PV, Christ ER, Bengtsson BA. Growth hormone deficiency in adulthood and the effects of growth hormone replacement: a review. Growth Hormone Research Society Scientific Committee. J Clin Endocrinol Metab. 1998;83(2):382-95. [Medline]. [Full Text].

  8. de Boer H, Blok GJ, Van der Veen EA. Clinical aspects of growth hormone deficiency in adults. Endocr Rev. Feb 1995;16(1):63-86. [Medline]. [Full Text].

  9. Ferrante E, Malavazos AE, Giavoli C, Ermetici F, Coman C, Bergamaschi S, et al. Epicardial fat thickness significantly decreases after short-term growth hormone (GH) replacement therapy in adults with GH deficiency. Nutr Metab Cardiovasc Dis. Nov 23 2011;[Medline].

  10. Bates AS, Van't Hoff W, Jones PJ. The effect of hypopituitarism on life expectancy. J Clin Endocrinol Metab. 1996;81(3):1169-72. [Medline]. [Full Text].

  11. Utz AL, Yamamoto A, Hemphill L, et al. Growth hormone deficiency by GHRH/arginine testing criteria predicts increased cardiovascular risk markers in normal young overweight and obese women. J Clin Endocrinol Metab. Apr 29 2008;[Medline]. [Full Text].

  12. Shalet SM, Toogood A, Rahim A. The diagnosis of growth hormone deficiency in children and adults. Endocr Rev. Apr 1998;19(2):203-23. [Medline]. [Full Text].

  13. Johannsson G. Management of adult growth hormone deficiency. Endocrinol Metab Clin North Am. Mar 2007;36(1):203-20. [Medline].

  14. Bidlingmaier M, Strasburger CJ. What endocrinologists should know about growth hormone measurements. Endocrinol Metab Clin North Am. Mar 2007;36(1):101-8. [Medline].

  15. Biller BM, Samuels MH, Zagar A, et al. Sensitivity and specificity of six tests for the diagnosis of adult GH deficiency. J Clin Endocrinol Metab. May 2002;87(5):2067-79. [Medline]. [Full Text].

  16. Kageyama K, Nigawara T, Sakihara S, et al. Diagnostic usefulness of the growth hormone-releasing peptide-2 test as a substitute for the insulin tolerance test in hypopituitarism. Endocr J. May 21 2008;[Medline]. [Full Text].

  17. Attanasio AF, Shalet SM. Growth hormone and the transition from puberty into adulthood. Endocrinol Metab Clin North Am. Mar 2007;36(1):187-201. [Medline].

  18. Geffner ME. Transition to the adult endocrine clinic: testing pituitary function - what tests and when?. Growth Horm IGF Res. Aug 2003;13 Suppl A:S117-21. [Medline].

  19. American Association of Clinical Endocrinologists medical guidelines for clinical practice for growth hormone use in adults and children--2003 update. Endocr Pract. Jan-Feb 2003;9(1):64-76. [Medline].

  20. Bulow B, Hagmar L, Mikoczy Z. Increased cerebrovascular mortality in patients with hypopituitarism. Clin Endocrinol (Oxf). 1997;46(1):75-81. [Medline].

  21. Chipman JJ, Attanasio AF, Birkett MA. The safety profile of GH replacement therapy in adults. Clin Endocrinol (Oxf). Apr 1997;46(4):473-81. [Medline].

  22. Fowelin J, Attvall S, Lager I. Effects of treatment with recombinant human growth hormone on insulin sensitivity and glucose metabolism in adults with growth hormone deficiency. Metabolism. Nov 1993;42(11):1443-7. [Medline].

  23. Koller EA, Green L, Gertner JM. Retinal changes mimicking diabetic retinopathy in two nondiabetic, growth hormone-treated patients. J Clin Endocrinol Metab. Jul 1998;83(7):2380-3. [Medline]. [Full Text].

  24. Saggese G, Ranke MB, Saenger P. Diagnosis and treatment of growth hormone deficiency in children and adolescents: towards a consensus. Ten years after the Availability of Recombinant Human Growth Hormone Workshop held in Pisa, Italy, 27-28 March 1998. Horm Res. 1998;50(6):320-40. [Medline].

  25. Shalet SM. Growth hormone outgrows growth. Clin Endocrinol (Oxf). Jul 2004;61(1):1-9. [Medline].

  26. Stavrou S, Kleinberg DL. Diagnosis and management of growth hormone deficiency in adults. Endocrinol Metab Clin North Am. Sep 2001;30(3):545-63. [Medline].

  27. Tanaka T, Cohen P, Clayton PE, et al. Diagnosis and management of growth hormone deficiency in childhood and adolescence--part 2: growth hormone treatment in growth hormone deficient children. Growth Horm IGF Res. Oct 2002;12(5):323-41. [Medline].

  28. Vance ML, Mauras N. Growth hormone therapy in adults and children [see comments]. N Engl J Med. Oct 14 1999;341(16):1206-16. [Medline].

 
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