GH replacement has been offered to children with GH deficiency (GHD) for 40 years; with time, however, and the increasing availability of recombinant derived GH, the threshold cut-off used to define GH status utilising provocative tests has been relaxed, leading to diagnostic dilemmas; this is particularly relevant as the growth velocity of a child, short from almost any cause, can be improved if he/she receives enough GH.
The advent of adult GH replacement paradoxically is beginning to transform paediatric GH practice due to the increasing awareness that GH impacts upon many important biological endpoints other than growth.
In addition the realisation that adults with GHD of childhood onset differ significantly from adults in whom the GHD is acquired in adult life in terms of IGF-I status, lipid profile, quality of life, body composition and skeletal mass have broadened the purpose of childhood GH replacement beyond improving height alone.
In adult life GH treatment has been restricted primarily to those patients with documented severe GHD; although increasing off-license use of GH in the normal elderly is being explored on the grounds that the somatopause, i.e. the natural decline of GH secretion with age, is itself a form of GHD. 24 hour GH secretory status, however, is reduced by 90% in the elderly with hypothalamic-pituitary disease compared with age-matched controls yet the impact of the severe GHD on a series of biological endpoints such as body composition and bone are attenuated in contrast to the findings in younger hypopituitary patients suggesting that lack of GH, per se, is not responsible for the physical and mental decline seen with ageing.
24 - 26 Mar 2003
British Endocrine Societies