Endocrine Abstracts

Growth hormone deficiency (GHD) observed in adults either presents in childhood and persists into adulthood (childhood-onset GHD [CO-GHD]) or arises in adulthood (adult-onset GHD [AO-GHD]). GHD in adults is most frequently caused by hypothalamic/pituitary lesions, often due to a pituitary adenoma or its associated treatments by surgery or radiotherapy. Adult GHD is linked to a wide spectrum of clinical features, including abnormal body composition, reduced bone mineral density, decreased muscle strength and exercise capacity, unfavorable metabolic profile, and impaired physiological well-being and quality of life. Data from some studies also suggest that hypopituitary patients with untreated GHD may be predisposed to decreased life expectancy due to cardiovascular and cerebrovascular diseases, although an association between GHD and increased mortality has not been definitively proven. Since recombinant human GH was first introduced in the mid-1980s, clinical studies have shown that GH therapy increased lean body mass and decreased body fat, improved bone health, enhanced patient-reported quality of life, and reduced total cholesterol (TC) and low-density lipoprotein (LDL) cholesterol in adults with GHD, although its effects on cardiovascular risks and mortality have been inconclusive. Administration of long-term GH replacement in adults with GHD is overall well-tolerated, but concerns regarding potential risks of diabetes mellitus, new malignancy, tumor recurrence, and cardiovascular diseases still remain and will be discussed. Long-term surveillance studies of large cohorts and adequate controls are therefore needed for a better benefit-risk assessment. Finally, GHD across transition period appears as a specific situation which needs to be managed and discussed in a proper way.