eMedicine Specialties > Endocrinology > Pituitary Gland

Growth Hormone Replacement in Older Men: Differential Diagnoses & Workup

Author: Angela Gentili, MD, Director of Geriatrics Fellowship Program, Associate Professor, Department of Internal Medicine, Virginia Commonwealth University Health System and McGuire Veterans Affairs Medical Center
Coauthor(s): Robert A Adler, MD, Chief of Endocrinology and Metabolism, McGuire Veterans Affairs Medical Center; Professor, Departments of Internal Medicine and Epidemiology and Community Health, Virginia Commonwealth University
Contributor Information and Disclosures

Updated: Jan 11, 2008

Differential Diagnoses

Hypopituitarism (Panhypopituitarism)
Obesity
Sleep Disorders

Other Problems to Be Considered

Malnutrition
Hypogonadism
Decreased physical fitness

Workup

Laboratory Studies

  • A single measurement of plasma GH levels is difficult to interpret because of the pulsatile secretion of GH. levels of IGF-1 vary little during the day; therefore, assays of IGF-1 have been used as a better indicator of the status of the GH–IGF-1 axis. Plasma IGF-1 levels decrease with aging, and an inverse correlation exists between age and IGF-1 levels. A cutoff IGF-1 level cannot be used for diagnostic purposes because the GH–IGF-1 axis is influenced by other factors besides aging (see Pathophysiology). Furthermore, evidence of an association between IGF-1 levels and measures of muscle strength, body composition, and physical functioning in older adults is lacking.
  • The insulin tolerance test (ITT) has been considered the criterion standard test of choice to diagnose adult GHD. As long as adequate hypoglycemia is achieved, this test distinguishes GHD secondary to hypopituitarism from decreased GH secretion associated with aging or obesity. The ITT is contraindicated in patients with ischemic heart disease or seizure disorders, and many authorities prefer not to use the ITT in patients older than 60 years.9
  • In patients with contraindications to the ITT, the best alternative provocative tests is the combined administration of arginine and GHRH, with a performance close to the ITT. This test is well tolerated and does not have the potentially serious side effect of hypoglycemia. As GHRH stimulates the pituitary, this test can be misleading in patients with GHD of hypothalamic origin. In these patients, if ITT is contraindicated, arginine can be given alone using a lower GH cutoff.

More on Growth Hormone Replacement in Older Men

Overview: Growth Hormone Replacement in Older Men
Differential Diagnoses & Workup: Growth Hormone Replacement in Older Men
Treatment & Medication: Growth Hormone Replacement in Older Men
Follow-up: Growth Hormone Replacement in Older Men
References
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References

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  2. Harman SM, Blackman MR. The Effects of Growth Hormone and Sex Steroid on Lean Body Mass, Fat Mass, Muscle Strength, Cardiovascular Endurance and Adverse Events in Healthy Elderly Women and Men. Horm Res. 2003;60:121-124. [Medline].

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Further Reading

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Keywords

somatopause, hyposomatotropism of aging, adult growth hormone deficiency, GHD, GH, somatopause of aging, hyposomatotropism of aging, growth hormone-releasing hormone, GHRH, growth hormone-releasing peptide, GHRP, pituitary gland, hypopituitarism, insulin tolerance test, ITT

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Contributor Information and Disclosures

Author

Angela Gentili, MD, Director of Geriatrics Fellowship Program, Associate Professor, Department of Internal Medicine, Virginia Commonwealth University Health System and McGuire Veterans Affairs Medical Center
Angela Gentili, MD is a member of the following medical societies: American Geriatrics Society
Disclosure: Nothing to disclose.

Coauthor(s)

Robert A Adler, MD, Chief of Endocrinology and Metabolism, McGuire Veterans Affairs Medical Center; Professor, Departments of Internal Medicine and Epidemiology and Community Health, Virginia Commonwealth University
Robert A Adler, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Federation for Medical Research, American Society for Bone and Mineral Research, and Endocrine Society
Disclosure: Eli Lilly Consulting fee Consulting

Medical Editor

Barry J Goldstein, MD, PhD, Director, Division of Endocrinology, Diabetes and Metabolic Diseases, Professor, Department of Internal Medicine, Thomas Jefferson University
Barry J Goldstein, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American College of Clinical Endocrinologists, American College of Physicians-American Society of Internal Medicine, American Diabetes Association, and Endocrine Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

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.

CME Editor

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.

 
 
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