Replacement Therapy in Adults with GHD: How to Treat and Monitor.

The replacement therapy of growth hormone (GH) in adults suffering from GH deficiency (GHD) still presents several challenges and uncertainties for the clinical endocrinologist. The decision to initiate treatment for GHD in adults necessitates a careful and personalized evaluation of potential benefits and risks. Although improvements in body composition, bone health, cardiovascular risk factors, and quality of life have been observed, evidence supporting a reduction in cardiovascular events and mortality is still inadequate, and treatment expenses remain high. To optimize treatment outcomes while minimizing side effects, it is recommended to initiate GH replacement therapy with low doses, aiming for a proper clinical response and insulin-like growth factor-I levels within the age-appropriate reference range. Despite being generally safe, certain aspects of GH replacement therapy require continuous long-term monitoring, including the potential risks of glucose intolerance, recurrence of pituitary/hypothalamic tumors, and cancer.