Growth Hormone Deficiency 

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

Background

The somatotroph cells of the anterior pituitary gland produce growth hormone. The hormone's secretion is stimulated by growth hormone – releasing hormone (GHRH) and is inhibited by somatostatin, both of which are produced by the hypothalamus.

The clinical manifestations of growth hormone deficiency (GHD) are variable, depending on the age of onset.[1] Children usually present with short stature, while adults have reduced physical performance and impaired psychological well-being.

The goals of growth hormone therapy differ in children and adults. In children, therapy promotes linear growth and restores body composition[2, 3] ; in adults, the goals are to improve conditioning and strength, to restore normal body composition, and to improve the quality of life.[4, 5, 6]

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Pathophysiology

Growth hormone promotes linear growth by regulating the endocrine and paracrine production of insulinlike growth factor 1 (IGF-1), which is produced by the liver and other target tissues, including the epiphyseal growth plate. Growth hormone's diverse metabolic actions also include anabolic, lipolytic, and diabetogenic effects.[7, 8]

GHD results in alterations in the physiology of different systems of the body, manifesting in increased subcutaneous visceral fat[9] and decreased muscle mass, bone density, and exercise performance.[7, 8]

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Epidemiology

Frequency

United States

The incidence of short stature associated with severe childhood GHD has been estimated in several studies to range between 1 per 4,000 to 1 per 10,000 live children. About 20,000 children per year receive growth hormone therapy, and approximately 4,000 new children are diagnosed annually as candidates for this treatment.

The exact prevalence of adult-onset GHD is not known. Approximately 35,000 adults have GHD, and about 6,000 new adult patients are diagnosed annually.

International

No data are available.

Mortality/Morbidity

Adult GHD is associated with the following problems[4, 5] :

  • Reduced bone mineral density and increased risk of osteoporotic bone fractures
  • Impaired cardiac function
  • Central obesity
  • Increased insulin sensitivity
  • Reduced exercise capacity
  • Emotional disturbances
  • Decreased quality of life

Epidemiologic data suggest that adults with GHD have reduced life expectancy. This increased mortality is probably attributable to premature cardiovascular disease.[10, 11]

Age

In children, the age of presentation varies with respect to the time of onset and the degree of GHD. Children with complete absence of growth hormone secretion usually present before reaching the age of 3 years, whereas those with lesser degrees of deficiency present at older ages.

In adults, the age of presentation often coincides with the discovery of pituitary tumors, usually between the fourth and fifth decades of life.

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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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  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].

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  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].

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