Growth Hormone Deficiency in Adults Medication

Updated: Jun 26, 2018
  • Author: Mohsen S Eledrisi, MD, FACP, FACE; Chief Editor: George T Griffing, MD  more...
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Medication

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and prevent complications.

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Growth Hormones

Class Summary

Growth hormones (GHs) are used for recombinant GH treatment.

Human recombinant growth hormone (Humatrope, Genotropin, Genotropin Miniquick, Omnitrope)

Human recombinant growth hormone is produced by recombinant deoxyribonucleic acid (DNA) technology. It stimulates the growth of linear bone, skeletal muscle, and organs and stimulates erythropoietin, increasing red blood cell mass. Actions are either direct or from the hepatic production of IGF-I. It 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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Diagnostic Agents

Class Summary

Macimorelin is the first oral test available for diagnosis of GH deficiency.

Macimorelin (Macrilen)

Macimorelin is an oral ghrelin agonist. Ghrelin is a neuropeptide released mainly from cells in the stomach and pancreas in response to hunger and is a growth hormone-releasing peptide. It stimulates GH release by activating GH secretagogue receptors present in the pituitary and hypothalamus. Macimorelin is indicated for diagnosis of adult growth hormone deficiency.

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