New Guidelines for the Diagnosis of Growth Hormone Deficiency in Adults

Background: The task of diagnosing growth hormone deficiency (GHD) in adults is cumbersome because of the paucity of biological endpoints. Consequently, over the past decade different organizations have attempted to develop homogeneous criteria and methodology for worldwide use. GHD should be biochemically confirmed within an appropriate clinical context – but only if there is the intention to treat. Clinically, patients investigated for GHD should include those with signs and symptoms or a past history of hypothalamo-pituitary dysfunction and those with a history of cranial irradiation, tumour treatment, traumatic brain injury or subarachnoid haemorrhage. Conclusions: Subjects with ≥3 pituitary hormone deficiencies plus a low insulin-like growth factor I level do not need provocative testing. For those who must be tested, arguably the most commonly used provocative tests are the insulin tolerance test and the glucagon, GH-releasing hormone (GHRH) + arginine and GHRH + GH-releasing hexapeptide tests. Cutoffs differ across tests and results may be influenced by gender, age, body mass index and the assay reference preparation.

[1]  R. Cantu Brief Communication: Pituitary Volume and Function in Competing and Retired Male Boxers , 2009 .

[2]  E. Ghigo,et al.  Diagnosis of adult GH deficiency. , 2008, Growth hormone & IGF research : official journal of the Growth Hormone Research Society and the International IGF Research Society.

[3]  K. Ho,et al.  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 , 2007 .

[4]  F. Casanueva,et al.  Effect of obesity and morbid obesity on the growth hormone (GH) secretion elicited by the combined GHRH + GHRP‐6 test , 2006, Clinical endocrinology.

[5]  M. Kołtowska-Häggström,et al.  Isolated growth hormone (GH) deficiency in adult patients: baseline clinical characteristics and responses to GH replacement in comparison with hypopituitary patients. A sub-analysis of the KIMS database. , 2005, Growth hormone & IGF research : official journal of the Growth Hormone Research Society and the International IGF Research Society.

[6]  J. Phillips,et al.  Anterior pituitary dysfunction in survivors of traumatic brain injury. , 2004, The Journal of clinical endocrinology and metabolism.

[7]  E. Ghigo,et al.  The usefulness of the combined growth hormone (GH)-releasing hormone and arginine stimulation test in the diagnosis of radiation-induced GH deficiency is dependent on the post-irradiation time interval. , 2003, The Journal of clinical endocrinology and metabolism.

[8]  H. Gharib,et al.  American Association of Clinical Endocrinologists medical guidelines for clinical practice for growth hormone use in adults and children--2003 update. , 2003, Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists.

[9]  D. Cook,et al.  Sensitivity and specificity of six tests for the diagnosis of adult GH deficiency. , 2002, The Journal of clinical endocrinology and metabolism.

[10]  J. Mesa,et al.  Growth hormone release after glucagon as a reliable test of growth hormone assessment in adults , 2002, Clinical endocrinology.

[11]  Brenda J. Crowe,et al.  Which patients do not require a GH stimulation test for the diagnosis of adult GH deficiency? , 2002, The Journal of clinical endocrinology and metabolism.

[12]  D. Clemmons Commercial Assays Available for Insulin-Like Growth Factor I and Their Use in Diagnosing Growth Hormone Deficiency , 2004, Hormone Research in Paediatrics.

[13]  F. Casanueva,et al.  GH-releasing hormone and GH-releasing peptide-6 for diagnostic testing in GH-deficient adults , 2000, The Lancet.

[14]  J. Veldhuis,et al.  Pathophysiology of the neuroregulation of growth hormone secretion in experimental animals and the human. , 1998, Endocrine reviews.

[15]  E. Arvat,et al.  Comparison between insulin-induced hypoglycemia and growth hormone (GH)-releasing hormone + arginine as provocative tests for the diagnosis of GH deficiency in adults. , 1998, The Journal of clinical endocrinology and metabolism.

[16]  P. Sönksen,et al.  Consensus guidelines for the diagnosis and treatment of adults with growth hormone deficiency. Growth Hormone Research Society. , 1998, Growth hormone & IGF research : official journal of the Growth Hormone Research Society and the International IGF Research Society.

[17]  L. Carlsson,et al.  Growth hormone (GH) assays: influence of standard preparations, GH isoforms, assay characteristics, and GH-binding protein. , 1997, Clinical chemistry.

[18]  F. Casanueva,et al.  Blocked growth hormone-releasing peptide (GHRP-6)-induced GH secretion and absence of the synergic action of GHRP-6 plus GH-releasing hormone in patients with hypothalamopituitary disconnection: evidence that GHRP-6 main action is exerted at the hypothalamic level. , 1995, The Journal of clinical endocrinology and metabolism.

[19]  P. Sönksen,et al.  The Diagnosis of Growth Hormone Deficiency in Adults , 1997 .

[20]  A. Williams Diagnosis of growth hormone deficiency in adults. , 1994, Lancet.

[21]  N. Skakkebaek,et al.  BENEFICIAL EFFECTS OF GROWTH HORMONE TREATMENT IN GH-DEFICIENT ADULTS , 1989, The Lancet.