Testing Growth Hormone Deficiency in Adults

Abstract

Growth hormone deficiency (GHD) in adults is a recognized syndrome which is defined biochemically within an appropriate clinical context. Clinically, patients investigated for GHD should include those with signs and symptoms of hypothalamic-pituitary disease, those who have received cranial irradiation or tumor treatment and those with traumatic brain injury or subarachnoid hemorrhage. Patients with three or more pituitary hormone deficiencies and an IGF-I below the reference range do not require provocative testing. The other patients need a provocative test of GH secretory reserve for the diagnosis of GHD. Insulin tolerance test is considered the diagnostic test of choice, however, the GH-releasing hormone (GHRH)+arginine, the GHRH+growth hormone-releasing peptide and the glucagon stimulation tests are well validated alternative tests in adults. Cutoffs differ across tests and results may be influenced by gender, age, body mass index, and the assay reference preparation.

Androgen Receptor Gene CAG Repeat Polymorphism Regulates the Metabolic Effects of Testosterone Replacement Therapy in Male Postsurgical Hypogonadotropic Hypogonadism

“…1000 mg of undecanoate testosterone was administered intramuscularly after 6 weeks before the first injection (loading dose), followed by similar injections every 10–14 weeks, depending on blood testosterone values and clinical symptoms [21]. All subjects presented both somatotropic and gonadotropic function deficits [19, 20, 22]; among them, four had also thyreotropic [23], two also corticotropic [24], and three both thyreotropic and corticotropic function deficits. All patients were treated with appropriate doses of glucocorticoid (cortisone acetate, 37.5–50 mg daily), somatotropic (recombinant human GH, 0.3–0.6 mg daily), and thyroid (levothyroxine, 75–100  μ g daily) replacement therapy, depending on the specific hormone deficit.…”

Prevalence of hypopituitarism after intracranial operations not directly associated with the pituitary gland

“…In cases where a GHRH/arginine test was performed, body mass index (BMI) dependent cut-offs were used [17]. Partial GHD was defined as patients with IGF-I levels within the age- and sex-related reference range and a pathological ITT or GHRH/arginine test.…”

“…Partial GHD was defined as patients with IGF-I levels within the age- and sex-related reference range and a pathological ITT or GHRH/arginine test. We defined severe GHD as a GH peak after ITT < 3 μg/l [18] or a GH peak following the GHRH/arginine test < 11 μg/l if BMI was < 25 [17]. …”

Effects of GH replacement therapy on thyroid volume and nodule development in GH deficient adults: a retrospective cohort study

“…Diagnosis had been made, according to the current guidelines (23). GHD was idiopathic in 13 CO patients (one patient being affected by congenital panhypopituitarism due to septo-optic dysplasia diagnosed at age 6), and in the other 83 cases acquired after surgery and/or radiotherapy in the pituitary region (nZ15, of whom 12 affected by pituitary adenomas, two by craniopharyngiomas, and one by meningioma), or due to pituitary macroadenomas (nZ28), empty sella (nZ19), craniopharyngiomas (nZ15), granulomatous or autoimmune hypophysitis (nZ4), or Rathke's cleft cysts (nZ2).…”