Growth Hormone Deficiency in Adults Clinical Presentation

Updated: Mar 06, 2018
  • Author: Mohsen S Eledrisi, MD, FACP, FACE; Chief Editor: George T Griffing, MD  more...
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Presentation

History

Patients with GH deficiency usually have a history of pituitary tumors that may have been treated with surgery or radiation, or they may have had a history of head trauma.

Some patients also have manifestations of deficiency of the other pituitary hormones, such as gonadal, adrenal, and thyroid hormones.

The symptoms of GH deficiency in adults are often nonspecific. Reported symptoms include low physical and mental energy, decreased muscle strength and exercise tolerance, increased weight or difficulty losing weight, poor memory, emotional instability, and impaired sleep (7,8). [6, 7] Some patients are asymptomatic.

Most patients have a normal physical examination. Some patients may have reduced skeletal muscle and lean body mass and increased fat mass, mainly in the abdominal region. [8]

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Complications

GH deficiency has been associated with cardiovascular disease, osteopenia/osteoporosis, alteration in body composition, decreased life expectancy, psychological disturbances, and insulin resistance.​

Cardiovascular disease

Early epidemiological data showed that patients with hypopituitarism who were on hormone replacement therapy, not including growth hormone, had increased cardiac events, suggesting an association of GH deficiency with cardiovascular disease. [9, 10, 11, 12, 13] Patients with GH deficiency have increased rates of the presence of markers of cardiovascular disease, such as greater intima-media thickness of carotid arteries, reduced left ventricular mass, decreased ejection fraction, high levels of serum LDL cholesterol and triglycerides, low levels of HDL cholesterol, and high coronary calcium scores. [10, 11, 12, 14] GH therapy improves certain markers of cardiovascular disease, such as serum lipids (reduction of LDL cholesterol levels and increase in HDL cholesterol levels), systolic function, intima-media thickness of carotid arteries, endothelial function, left ventricular mass, and cardiac output. [10, 15, 16, 17] However, evidence is limited regarding the effect of GH replacement therapy on cardiovascular morbidity and mortality. [9, 10]

Osteopenia/osteoporosis

Patients with GH deficiency have reduced bone mineral density and increased rates of fractures. [18, 19]   A gender difference in the response to GH treatment has been hypothesized, as bone mineral density has been show to improve with this therapy more in men than in women (21,22,23). [20, 21, 22] The effect of GH therapy on fracture rate was less pronounced, with stabilization of the incidence of clinical fracture after GH treatment. [20]

Effect on body composition

Patients with GH deficiency tend to have a relative increase in fat mass with a preferential increase in visceral fat and a relative decrease in muscle mass. [23, 24] GH therapy decreases total body fat and increases muscle mass. [23, 25] Some, but not all, studies have shown increased muscle strength along with improved exercise capacity and physical performance after GH therapy. [25, 26, 27]

Decreased life expectancy

Patients with hypopituitarism have decreased life expectancy compared with age- and gender-matched healthy people despite replacement with adrenal, thyroid, and gonadal hormones. [28, 29, 30] Therefore, it has been speculated that GH deficiency in patients with hypopituitarism is associated with premature mortality. However, other factors could contribute to the increased mortality in these patients, including the following [5] :

  • Administration of cranial radiation to treat the pituitary disease.
  • Different thyroid, gonadal, and glucocorticoid replacement regimens, including what is currently considered high doses of glucocorticoids.
  • Effective treatments for dyslipidemia and hypertension being unavailable during the survey times.
  • In addition, there are no published studies on the effect of GH therapy on mortality.

Psychological disturbances

Compared with matched healthy persons, patients with GH deficiency have lower quality-of-life scores, with reduced energy, social isolation, and disturbed sexual life. [31]

Insulin resistance

Impaired glucose metabolism characterized by insulin resistance and fasting hyperinsulinemia has been reported in patients with GH deficiency. [32]

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