Diagnostic Considerations

Distinguishing idiopathic adult growth hormone deficiency (IAGHD) in older patients with no obvious pituitary lesion from hyposomatotropism of aging is challenging. The clinical features of adult GHD (eg, increased fat and decreased lean body mass, low energy, and mood disorders) are nonspecific and IAGHD may be misdiagnosed if based on the results of inaccurate single serum GH measurement. Because diagnosis requires costly repeat provocative testing, it has been proposed that evaluation be limited to the patients with history that includes one of the following risk factors^[13]:

Surgery or radiation therapy for a pituitary or brain lesion
Hypothalamic-pituitary lesion, including pituitary adenoma, craniopharyngioma, cyst, hypothalamic tumor, or rare mass due to secondary tumor metastasis
Traumatic brain injury or treatment of a brain lesion
Systemic illness known to also impact the hypothalamic-pituitary axis including a granulomatous disorder; viral, bacterial, or fungal infections; or malignancy

Differential Diagnoses

Workup

Sattler FR. Growth hormone in the aging male. Best Pract Res Clin Endocrinol Metab. 2013 Aug. 27(4):541-55. [QxMD MEDLINE Link]. [Full Text].
Waters DL, Baumgartner RN, Garry PJ, Vellas B. Advantages of dietary, exercise-related, and therapeutic interventions to prevent and treat sarcopenia in adult patients: an update. Clin Interv Aging. 2010. 5:259-70. [QxMD MEDLINE Link].
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(Suppl 1):121-4. [QxMD MEDLINE Link].
Harman SM, Blackman MR. Use of growth hormone for prevention or treatment of effects of aging. J Gerontol A Biol Sci Med Sci. 2004. 59:652-8. [QxMD MEDLINE Link].
Kiel DP, Puhl J, Rosen CJ, Berg K, Murphy JB, MacLean DB. Lack of an association between insulin-like growth factor-I and body composition, muscle strength, physical performance or self-reported mobility among older persons with functional limitations. J Am Geriatr Soc. 1998 Jul. 46(7):822-8. [QxMD MEDLINE Link].
Sherlock M, Toogood AA. Aging and the growth hormone/insulin like growth factor-I axis. Pituitary. 2007. 10(2):189-203. [QxMD MEDLINE Link].
Liu H, Bravata DM, Olkin I, et al. Systematic review: the safety and efficacy of growth hormone in the healthy elderly. Ann Intern Med. 2007 Jan 16. 146(2):104-15. [QxMD MEDLINE Link].
[Guideline] Molitch ME, Clemmons DR, Malozowski S, et al. Evaluation and treatment of adult growth hormone deficiency: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2006 May. 91(5):1621-34. [QxMD MEDLINE Link]. [Full Text].
Lin L, Saha PK, Ma X, et al. Ablation of ghrelin receptor reduces adiposity and improves insulin sensitivity during aging by regulating fat metabolism in white and brown adipose tissues. Aging Cell. 2011 Dec. 10(6):996-1010. [QxMD MEDLINE Link].
Holzenberger M. Igf-I signaling and effects on longevity. Nestle Nutr Workshop Ser Pediatr Program. 2011. 68:237-49. [QxMD MEDLINE Link].
Stochholm K, Berglund A, Juul S, Gravholt CH, Christiansen JS. Socioeconomic factors do not but GH treatment does affect mortality in adult-onset growth hormone deficiency. J Clin Endocrinol Metab. 2014 Nov. 99(11):4141-8. [QxMD MEDLINE Link]. [Full Text].
Mihaila S, Mincu RI, Rimbas RC, et al. Growth hormone deficiency in adults impacts left ventricular mechanics: a two-dimensional speckle-tracking study. Can J Cardiol. 2015 Jun. 31(6):752-9. [QxMD MEDLINE Link].
Melmed S. Idiopathic adult growth hormone deficiency. J Clin Endocrinol Metab. 2013 Jun. 98(6):2187-97. [QxMD MEDLINE Link]. [Full Text].
[Guideline] Fleseriu M, Hashim IA, Karavitaki N, et al. Hormonal replacement in hypopituitarism in adults: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016 Nov. 101(11):3888-921. [QxMD MEDLINE Link]. [Full Text].
[Guideline] Cook DM, Yuen KC, Biller BM, Kemp SF, Vance ML, for the 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. [QxMD MEDLINE Link].
American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015 Nov. 63(11):2227-46. [QxMD MEDLINE Link].
Veldhuis JD, Iranmanesh A, Weltman A. Elements in the pathophysiology of diminished growth hormone (GH) secretion in aging humans. Endocrine. 1997 Aug. 7(1):41-8. [QxMD MEDLINE Link].
Topaloglu O, Gokay F, Koparal SS, et al. Visceral fat measurement by ultrasound as a non-invasive method - can it be useful in evaluating subclinical atherosclerosis in male patients with hypopituitarism and growth hormone deficiency?. Endokrynol Pol. 2014. 65(3):195-202. [QxMD MEDLINE Link].
[Guideline] Ho KK. Consensus guidelines for the diagnosis and treatment of adults with GH deficiency II: a statement of the GH Research Society in association with the European Society for Pediatric Endocrinology, Lawson Wilkins Society, European Society of Endocrinology, Japan Endocrine Society, and Endocrine Society of Australia. Eur J Endocrinol. 2007 Dec. 157(6):695-700. [QxMD MEDLINE Link].
Rudman D, Feller AG, Nagraj HS, et al. Effects of human growth hormone in men over 60 years old. N Engl J Med. 1990 Jul 5. 323(1):1-6. [QxMD MEDLINE Link].
Kokshoorn NE, Biermasz NR, Roelfsema F, Smit JW, Pereira AM, Romijn JA. GH replacement therapy in elderly GH-deficient patients: a systematic review. Eur J Endocrinol. 2011 May. 164(5):657-65. [QxMD MEDLINE Link].
Samaras N, Papadopoulou MA, Samaras D, Ongaro F. Off-label use of hormones as an antiaging strategy: a review. Clin Interv Aging. 2014. 9:1175-86. [QxMD MEDLINE Link].
Urban RJ. Growth hormone and testosterone: anabolic effects on muscle. Horm Res Paediatr. 2011. 76 Suppl 1:81-3. [QxMD MEDLINE Link].
Brill KT, Weltman AL, Gentili A, et al. Single and combined effects of growth hormone and testosterone administration on measures of body composition, physical performance, mood, sexual function, bone turnover, and muscle gene expression in healthy older men. J Clin Endocrinol Metab. 2002 Dec. 87(12):5649-57. [QxMD MEDLINE Link].
Elgzyri T, Castenfors J, Hagg E, Backman C, Thoren M, Bramnert M. The effects of GH replacement therapy on cardiac morphology and function, exercise capacity and serum lipids in elderly patients with GH deficiency. Clin Endocrinol (Oxf). 2004 Jul. 61(1):113-22. [QxMD MEDLINE Link].
Haydar ZR, Blackman MR, Tobin JD, Wright JG, Fleg JL. The relationship between aerobic exercise capacity and circulating IGF-1 levels in healthy men and women. J Am Geriatr Soc. 2000 Feb. 48(2):139-45. [QxMD MEDLINE Link].
Baker LD, Barsness SM, Borson S, et al. Effects of growth hormone–releasing hormone on cognitive function in adults with mild cognitive impairment and healthy older adults: results of a controlled trial. Arch Neurol. 2012 Nov. 69(11):1420-9. [QxMD MEDLINE Link].
Bach MA, Rockwood K, Zetterberg C, et al. The effects of MK-0677, an oral growth hormone secretagogue, in patients with hip fracture. J Am Geriatr Soc. 2004 Apr. 52(4):516-23. [QxMD MEDLINE Link].
Papadakis MA, Grady D, Black D, et al. Growth hormone replacement in healthy older men improves body composition but not functional ability. Ann Intern Med. 1996 Apr 15. 124(8):708-16. [QxMD MEDLINE Link].
Kaiser FE, Silver AJ, Morley JE. The effect of recombinant human growth hormone on malnourished older individuals. J Am Geriatr Soc. 1991 Mar. 39(3):235-40. [QxMD MEDLINE Link].
Morley JE. Scientific overview of hormone treatment used for rejuvenation. Fertil Steril. 2013 Jun. 99(7):1807-13. [QxMD MEDLINE Link].
Borst SE. Interventions for sarcopenia and muscle weakness in older people. Age Ageing. 2004 Nov. 33(6):548-55. [QxMD MEDLINE Link].
Blackman MR, Sorkin JD, Munzer T, et al. Growth hormone and sex steroid administration in healthy aged women and men: a randomized controlled trial. JAMA. 2002 Nov 13. 288(18):2282-92. [QxMD MEDLINE Link].
Nutropin (R) [somatropin (rDNA origin) for injection] prescribing information. Genentech Inc. Available at http://www.gene.com/medical-professionals/medicines/nutropin-aq. Accessed: November 13, 2015.
Vitiello MV, Moe KE, Merriam GR, Mazzoni G, Buchner DH, Schwartz RS. Growth hormone releasing hormone improves the cognition of healthy older adults. Neurobiol Aging. 2006 Feb. 27(2):318-23. [QxMD MEDLINE Link].
Sellami M, Bragazzi NL, Slimani M, et al. The effect of exercise on glucoregulatory hormones: a countermeasure to human aging: insights from a comprehensive review of the literature. Int J Environ Res Public Health. 2019 May 15. 16(10):[QxMD MEDLINE Link]. [Full Text].
Gonzalez S, Windram JD, Sathyapalan T, Javed Z, Clark AL, Atkin SL. Effects of human recombinant growth hormone on exercise capacity, cardiac structure, and cardiac function in patients with adult-onset growth hormone deficiency. J Int Med Res. 2017 Dec. 45(6):1708-19. [QxMD MEDLINE Link]. [Full Text].
Kuzma M, Kuzmova Z, Zelinkova Z, et al. Impact of the growth hormone replacement on bone status in growth hormone deficient adults. Growth Horm IGF Res. 2014 Feb. 24(1):22-8. [QxMD MEDLINE Link].