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Growth hormone deficiency in adults

INTRODUCTION

Growth hormone deficiency in adults is important for two reasons: the evidence that growth hormone deficiency can have adverse effects and the availability of growth hormone preparations for treatment [1,2]. The clinical manifestations, diagnosis, and treatment of growth hormone deficiency in adults are discussed here. The decline in growth hormone secretion that occurs as a normal consequence of aging and growth hormone deficiency in children are discussed elsewhere. (See "Endocrine changes with aging" and "Diagnosis of growth hormone deficiency in children" and "Treatment of growth hormone deficiency in children".)

ETIOLOGY

The causes of growth hormone deficiency are the same as the causes of deficiencies of other pituitary hormones (table 1). (See "Causes of hypopituitarism".) A study of 172 adults with hypopituitarism found the following distribution of etiologies [3]:

  • A pituitary tumor or the consequences of treatment of the tumor, including surgery and/or radiation therapy — 76 percent
  • An extrapituitary tumor (eg, craniopharyngioma) — 13 percent
  • Cause unknown — 8 percent
  • Sarcoidosis — 1 percent
  • Sheehan's syndrome — 0.5 percent (see "Causes of hypopituitarism")

As a general rule, the secretion of growth hormone and gonadotropins is more likely to be affected by organic pituitary disease than that of corticotropin (ACTH) and thyrotropin (TSH). The likelihood of growth hormone deficiency in such patients has been estimated to range from approximately 45 percent in patients with no other pituitary hormone deficits to virtually 100 percent in patients with multiple deficits [4].

When growth hormone deficiency occurs in childhood due to any of the organic causes above, the deficiency will almost certainly persist into adulthood. In contrast, idiopathic growth hormone deficiency in childhood may not persist. This topic is discussed in detail elsewhere. (See "Treatment of growth hormone deficiency in children", section on 'Duration of therapy' and "Growth hormone treatment during the transition period".)

                        

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Literature review current through: 20.6: May 2012
This topic last updated: Feb 28, 2012
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