Diagnosis and treatment of growth hormone deficiency in adults: current perspectives

Purpose of reviewTo review recent developments in the clinical consequences, evaluation, and treatment of growth hormone deficiency in adults after completion of statural growth. Recent findingsAlthough pituitary adenomas and craniopharyngiomas remain the most common causes of adult growth hormone deficiency, other etiologies are now recognized, particularly head trauma of even moderate severity. Provocative growth hormone testing is important in the diagnostic process, but should only be conducted in the appropriate clinical context. Adult growth hormone deficiency is associated with subtle increases in cortisol synthesis, which may account for some of its features. Patients often have reduced quality of life scores and some impairment in cognitive performance, both improved by replacement therapy. A dosing strategy starting with a low dose, independent of weight, gradually titrated upwards is as effective as traditional weight-based dosing. Although growth hormone should not be given to patients with active malignancies, there is no increased risk of recurrent or new cancers with adult growth hormone replacement. Longer-acting growth hormone preparations are under development. SummaryDespite a solid base of evidence, the high cost of growth hormone replacement causes concerns about its cost-effectiveness. Objective validated measures to assess this in adult growth hormone deficiency are lacking, but a consensus as to its appropriate use is emerging.