Growth hormone - not only for growth, but for life?
Growth hormone (GH) is secreted throughout life - albeit in diminishing quantities with age. Its many different physiological actions have been known since the classical work of Maurice Raben in the late fifties. However, due to lack of the hormone, replacement therapy was for many years restricted to the pediatric treatment of growth disorder, and its place in medicine became tightly connected with growth, and growth alone. Since the mid eighties natural sequence GH have been available in principle in unlimited quantities, and therefore a renewed interest in the hormone as a drug has been seen. The results from the first controlled clinical trial on the effects of GH replacement to adult patients with GH deficiency (GHD) were reported in 1989. Although adult GHD is by now a registered indication for GH replacement in many countries worldwide, the acceptance of the need for this treatment has been somewhat hesitant, both from the clinical field but also as regards reimbursement. At present the clinical syndrome of adult GHD is well described. These include clear (and expected) abnormalities in intermediary metabolism, which translates into profound changes in body composition and function. Some (but not all) studies have also reported rather convincing positive effects on quality of life and psychosocial function - matching the presence of GH receptors most over the body, including the CNS. Whether or not GH replacement will prolong life expectancy is presently not known. If, however, we want patients with profound GHD to be given a fair chance for a life as normal as possible, I have no doubt, that GH should be included in our clinical considerations, when designing the individual replacement therapy for our hypopituitary patients.