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Growth Hormone Deficiency in Adults Treatment & Management

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

Medical Care

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

Follow-up is usually planned at intervals of 1-2 months when the dose of GH can be adjusted by increments of 0.1-0.2 mg/day based on the clinical response, serum IGF-1 levels, and side effects. Longer time intervals and smaller dose increments are suggested for older patients.   

Serum IGF-1 levels are the main determinant for adjusting the dose of GH. No studies are available to guide this decision. A commonly used target is the upper half of the normal range appropriate for age and sex, unless significant side effects develop.[6]

Once maintenance doses of GH are achieved, follow-up is provided at intervals of 6 months. Monitoring includes clinical evaluation, assessment of side effects, and measurement of serum IGF-1, fasting glucose, and lipid profile. Quality of life (QOL) is also assessed using standardized questionnaires. If the initial bone mineral density findings, measured by DXA scan, are abnormal, repeat testing at intervals of 2-3 years is recommended.[6] .

No studies are available regarding the optimal length of GH replacement therapy. Patients with childhood GH deficiency who attained adult height and had persistent deficiency on retesting should continue to receive GH therapy.[6]  

GH therapy can also be continued indefinitely if benefits such as significant improvement in quality of life and objective improvements in biochemistry and body composition are observed. If no objective or subjective benefits are seen after 1 year of treatment, discontinuation of GH therapy should be considered.[4]  



Consult with an endocrinologist.

Consult with a neurosurgeon for evaluation of pituitary tumors.

Contributor Information and Disclosures

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.


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

  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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