Endocrine Abstracts (2017) 49 MTE2 | DOI: 10.1530/endoabs.49.MTE2

Diagnosis and management of GH deficiency - from childhood to adulthood

Jens Jorgensen


Denmark.


Pituitary dwarfism has been known for many decades, originally as a component of organic panhypopituitarism. GH for clinical use was purified by Maurice Raben from human cadaveric pituitaries and tested for the first time and with success in 1957 in a patient with childhood onset disease. Moreover, pivotal short term studies on the metabolic effects were performed in both healthy and hypopituitary adults. The concomitant introduction of imunnoassays for GH led to the introduction of GH stim tests and recognition of isolated and idiopathic GHD. But the scarcity of GH for clinical use was a major limitation until the 1980s when biosynthetic GH became available. This opened the possibility of novel indications including GHD in adults (GHDA). The two first placebo-controlled studies in 1989 reported positive effects in both childhood- and adult-onset GHDA in terms of body composition and exercise capacity. This has since been corroborated in numerous trials, and it is also documented that discontinuation of GH in the transition from child to adulthood is unfavorable. Finally, there is indirect evidence to suggest that GH replacement in adults may reduce mortality and does not associate with increased cancer risk. Still, GH therapy in adults is by no means a fountain of youth, and there is no evidence to suggest that it is of any meaningful use in either normal or frail aging. This MTE will discuss this exiting journey from a personal point of view.

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