Growth Hormone Deficiency in Adults Medication
- Author: Mohsen S Eledrisi, MD, FACP, FACE; Chief Editor: George T Griffing, MD more...
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. The following regimen is suggested:
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.
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.
Growth hormones (GHs) are used for recombinant GH treatment.
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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