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Growth Hormone Deficiency in Adults Medication

  • Author: Mohsen S Eledrisi, MD, FACP, FACE; Chief Editor: George T Griffing, MD  more...
 
Updated: Sep 23, 2015
 

Medication Summary

Growth hormone (GH) replacement therapy is provided in the form of recombinant growth hormone.

Starting dose of GH depends on the age and clinical condition of the patient. A dose regimen that is based on age along with dose titration has been associated with less adverse effects compared with a weight-based regimen.[27]  The following regimen is suggested:[4]

  • Age younger than 30 years: 0.4-0.5 mg/day (may be higher for patients transitioning from pediatric treatment)
  • Age 30-60 years: 0.2-0.3 mg/day
  • Age >60 years or those with diabetes mellitus or prediabetes: 0.1-0.2 mg/day

For patients with adherence issues, a less frequent dose regimen such as alternate days or three times per week using the same total weekly dosage can be used.[4]  

The goals of pharmacotherapy are to restore normal growth hormone levels and to reduce morbidity. The main therapeutic goal of growth hormone treatment in children with growth hormone deficiency is to enable short children to achieve normal height, with early improvement of the psychosocial difficulties related to short stature.

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Growth hormones

Class Summary

Growth hormones (GHs) are used for recombinant GH treatment.

Human recombinant growth hormone (Humatrope, Genotropin, Nutropin)

 

Human recombinant growth hormone is currently widely available in subcutaneous injection form. 

Published data do not confirm an association between GH therapy and recurrence or regrowth of pituitary tumors or craniopharyngiomas. However, because of the possible association between increased IGF-1 levels and the risk of malignancy, there has been a theoretical concern that GH therapy could lead to regrowth of malignancies. Therefore, professional guidelines recommend not using GH therapy in patients with previous history of malignancy or in the presence of active malignancy.

GH therapy may increase the activity of cytochrome P-450 system and alter the clearance of some medications known to be metabolized by this system such as corticosteroids, anticonvulsants, sex steroids, cyclosporine. Therefore, monitoring is advised when such medications are used in patients receiving GH therapy.

The most common side effects of GH therapy are related to fluid retention and include paresthesia, joint stiffness, peripheral edema, arthralgia, myalgia, carpal tunnel syndrome and increased blood pressure. Most of these adverse effects improve with dose reduction. Older age, higher BMI and female gender confer higher risk of these complications.

GH therapy is associated with a mild increase in both fasting serum glucose and fasting plasma insulin levels. Patients with diabetes mellitus who receive GH therapy may require adjustment in their glucose-lowering medications. 

- Because GH therapy can decrease levels of serum free T4 and cortisol, regular monitoring of thyroid and adrenal function is recommended. Patients on concurrent thyroid or adrenal hormone replacement may need dose adjustments after starting GH therapy. Patients who have normal thyroid and adrenal function require monitoring of serum free T4 and assessment of the hypothalamic-pituitary-adrenal axis since GH therapy can unmask central hypothyroidism and hypoadrenalism.

Patients who are on testosterone-replacement therapy may require their GH doses to be decreased as testosterone can potentiate GH action and  exacerbate GH-induced adverse effects.

Women who are taking oral estrogen replacement usually need higher doses of GH, but those on transdermal estrogen preparations may not.

 

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Contributor Information and Disclosures
Author

Mohsen S Eledrisi, MD, FACP, FACE Senior Consultant, Department of Medicine/Endocrinology, Hamad Medical Corporation, Qatar

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

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

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 and Translational Research, Endocrine Society

Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD Professor Emeritus 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, International Society for Clinical Densitometry, Southern Society for Clinical Investigation, American College of Medical Practice Executives, American Association for Physician Leadership, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical and Translational Research, Endocrine Society

Disclosure: Nothing to disclose.

Additional Contributors

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 Association for Physician Leadership, American College of Physicians, American Geriatrics Society, Endocrine Society, Gerontological Society of America, Association of Professors of Medicine

Disclosure: Nothing to disclose.

Acknowledgements

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

References
  1. Cuneo RC, Salomon F, McGauley GA, Sönksen PH. The growth hormone deficiency syndrome in adults. Clin Endocrinol (Oxf). 1992 Nov. 37(5):387-97. [Medline].

  2. Cummings DE, Merriam GR. Growth hormone therapy in adults. Annu Rev Med. 2003. 54:513-33. [Medline].

  3. Stochholm K, Gravholt CH, Laursen T, Jorgensen JO, Laurberg P, Andersen M. Incidence of GH deficiency - a nationwide study. Eur J Endocrinol. 2006 Jul. 155(1):61-71. [Medline].

  4. Cook DM, Yuen KC, Biller BM, Kemp SF, Vance ML, American Association of Clinical Endocrinologists. American Association of Clinical Endocrinologists medical guidelines for clinical practice for growth hormone use in growth hormone-deficient adults and transition patients - 2009 update. Endocr Pract. 2009 Sep-Oct. 15 Suppl 2:1-29. [Medline].

  5. Rosilio M, Blum WF, Edwards DJ, Shavrikova EP, Valle D, Lamberts SW, et al. Long-term improvement of quality of life during growth hormone (GH) replacement therapy in adults with GH deficiency, as measured by questions on life satisfaction-hypopituitarism (QLS-H). J Clin Endocrinol Metab. 2004 Apr. 89 (4):1684-93. [Medline].

  6. Molitch ME, Clemmons DR, Malozowski S, Merriam GR, Vance LM. Evaluation and treatment of adult growth hormone deficiency: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2011. 96:1587-1609.

  7. De Boer H, Blok GJ, Voerman HJ, De Vries PM, van der Veen EA. Body composition in adult growth hormone-deficient men, assessed by anthropometry and bioimpedance analysis. J Clin Endocrinol Metab. 1992 Sep. 75 (3):833-7. [Medline].

  8. Gazzaruso C, Gola M, Karamouzis I, Giubbini R, Giustina A. Cardiovascular risk in adult patients with growth hormone (GH) deficiency and following substitution with GH--an update. J Clin Endocrinol Metab. 2014 Jan. 99 (1):18-29. [Medline].

  9. Svensson J, Bengtsson BA, Rosen T, Oden A, Johannsson G. Malignant disease and cardiovascular morbidity in hypopituitary adults with or without growth hormone replacement therapy. J Clin Endocrinol Metab. 2004 Jul. 89 (7):3306-12. [Medline].

  10. Rosen T, Bengtsson BA. Premature mortality due to cardiovascular disease in hypopituitarism. Lancet. 1990 Aug 4. 336 (8710):285-8. [Medline].

  11. McCallum RW, Petrie JR, Dominiczak AF, Connell JM. Growth hormone deficiency and vascular risk. Clin Endocrinol (Oxf). 2002 Jul. 57 (1):11-24. [Medline].

  12. Colao A, Di Somma C, Rota F, Pivonello R, Savanelli MC, Spiezia S, et al. Short-term effects of growth hormone (GH) treatment or deprivation on cardiovascular risk parameters and intima-media thickness at carotid arteries in patients with severe GH deficiency. J Clin Endocrinol Metab. 2005 Apr. 90 (4):2056-62. [Medline].

  13. Cannavo S, Marini F, Curto L, Torre ML, de Gregorio C, Salamone I, et al. High prevalence of coronary calcifications and increased risk for coronary heart disease in adults with growth hormone deficiency. J Endocrinol Invest. 2011 Jan. 34 (1):32-7. [Medline].

  14. Colao A, Di Somma C, Spiezia S, Savastano S, Rota F, Savanelli MC, et al. Growth hormone treatment on atherosclerosis: results of a 5-year open, prospective, controlled study in male patients with severe growth hormone deficiency. J Clin Endocrinol Metab. 2008 Sep. 93 (9):3416-24. [Medline].

  15. Maison P, Chanson P. Cardiac effects of growth hormone in adults with growth hormone deficiency: a meta-analysis. Circulation. 2003 Nov 25. 108 (21):2648-52. [Medline].

  16. Wuster C, Abs R, Bengtsson BA, Bennmarker H, Feldt-Rasmussen U, et al. The influence of growth hormone deficiency, growth hormone replacement therapy, and other aspects of hypopituitarism on fracture rate and bone mineral density. J Bone Miner Res. 2001 Feb. 16 (2):398-405. [Medline].

  17. Appelman-Dijkstra NM, Claessen KM, Hamdy NA, Pereira AM, Biermasz NR. Effects of up to 15 years of recombinant human GH (rhGH) replacement on bone metabolism in adults with growth hormone deficiency (GHD): the Leiden Cohort Study. Clin Endocrinol (Oxf). 2014 Nov. 81 (5):727-35. [Medline].

  18. Snyder PJ, Biller BM, Zagar A, Jackson I, Arafah BM, et al. Effect of growth hormone replacement on BMD in adult-onset growth hormone deficiency. J Bone Miner Res. 2007 May. 22 (5):762-70. [Medline].

  19. Bex M, Abs R, Maiter D, Beckers A, Lamberigts G, Bouillon R. The effects of growth hormone replacement therapy on bone metabolism in adult-onset growth hormone deficiency: a 2-year open randomized controlled multicenter trial. J Bone Miner Res. 2002 Jun. 17 (6):1081-94. [Medline].

  20. Pappachan JM, Raskauskiene D, Kutty VR, Clayton RN. Excess mortality associated with hypopituitarism in adults: a meta-analysis of observational studies. J Clin Endocrinol Metab. 2015 Apr. 100 (4):1405-11. [Medline].

  21. Sherlock M, Ayuk J, Tomlinson JW, Toogood AA, Aragon-Alonso A, Sheppard MC, et al. Mortality in patients with pituitary disease. Endocr Rev. 2010 Jun. 31 (3):301-42. [Medline].

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

  23. Rosen T, Wiren L, Wilhelmsen L, Wiklund I, Bengtsson BA. Decreased psychological well-being in adult patients with growth hormone deficiency. Clin Endocrinol (Oxf). 1994 Jan. 40 (1):111-6. [Medline].

  24. Hartman ML, Crowe BJ, Biller BM, Ho KK, Clemmons DR, Chipman JJ, et al. Which patients do not require a GH stimulation test for the diagnosis of adult GH deficiency?. J Clin Endocrinol Metab. 2002 Feb. 87 (2):477-85. [Medline].

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

  26. 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 Jan. 88 (1):95-102. [Medline].

  27. Hoffman AR, Strasburger CJ, Zagar A, Blum WF, Kehely A, Hartman ML, et al. Efficacy and tolerability of an individualized dosing regimen for adult growth hormone replacement therapy in comparison with fixed body weight-based dosing. J Clin Endocrinol Metab. 2004 Jul. 89 (7):3224-33. [Medline].

  28. Arnold JR, Arnold DF, Marland A, Karavitaki N, Wass JA. GH replacement in patients with non-functioning pituitary adenoma (NFA) treated solely by surgery is not associated with increased risk of tumour recurrence. Clin Endocrinol (Oxf). 2009 Mar. 70 (3):435-8. [Medline].

  29. Buchfelder M, Kann PH, Wüster C, Tuschy U, Saller B, Brabant G, et al. Influence of GH substitution therapy in deficient adults on the recurrence rate of hormonally inactive pituitary adenomas: a case control study. Eur J Endocrinol. 2007 Aug. 157 (2):149-56. [Medline].

  30. Karavitaki N, Warner JT, Marland A, Shine B, Ryan F, Arnold J, et al. GH replacement does not increase the risk of recurrence in patients with craniopharyngioma. Clin Endocrinol (Oxf). 2006. 64:556-560.

  31. Jenkins PJ, Mukherjee A, Shalet SM. Does growth hormone cause cancer?. Clin Endocrinol (Oxf). 2006 Feb. 64 (2):115-21. [Medline].

  32. Holmes SJ, Shalet SM. Which adults develop side-effects of growth hormone replacement?. Clin Endocrinol (Oxf). 1995 Aug. 43 (2):143-9. [Medline].

  33. Maison P, Griffin S, Nicoue-Beglah M, Haddad N, Balkau B, et al. Impact of growth hormone (GH) treatment on cardiovascular risk factors in GH-deficient adults: a Metaanalysis of Blinded, Randomized, Placebo-Controlled Trials. J Clin Endocrinol Metab. 2004 May. 89 (5):2192-9. [Medline].

  34. Losa M, Scavini M, Gatti E, Rossini A, Madaschi S, et al. Long-term effects of growth hormone replacement therapy on thyroid function in adults with growth hormone deficiency. Thyroid. 2008 Dec. 18 (12):1249-54. [Medline].

  35. Giavoli C, Libe R, Corbetta S, Ferrante E, Lania A, et al. Effect of recombinant human growth hormone (GH) replacement on the hypothalamic-pituitary-adrenal axis in adult GH-deficient patients. J Clin Endocrinol Metab. 2004 Nov. 89 (11):5397-401. [Medline].

  36. Giannoulis MG, Sonksen PH, Umpleby M, Breen L, Pentecost C, Whyte M, et al. The effects of growth hormone and/or testosterone in healthy elderly men: a randomized controlled trial. J Clin Endocrinol Metab. 2006 Feb. 91 (2):477-84. [Medline].

  37. Cook DM, Ludlam WH, Cook MB. Route of estrogen administration helps to determine growth hormone (GH) replacement dose in GH-deficient adults. J Clin Endocrinol Metab. 1999 Nov. 84 (11):3956-60. [Medline].

 
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