Page 21 - GALENIKA MEDICAL JOURNAL

GROWTH HORMONE DEFICIENCY IN

ADULTS - DIAGNOSIS AND TREATMENT

Mirjana Doknić 1, 2
1 Faculty of Medicine, University of Belgrade, Belgrade, Serbia radiotherapy), and the replacement of other missing
2 Clinic for endocrinology, diabetes and metabolic diseases, University pituitary hormones. During the last two decades,
Clinical Center of Serbia, Belgrade, Serbiaja growth hormone therapy in adults has entered
routine clinical practice. The beneficial effects of this
Corresponding author: substitution are reflected in the body composition,

Prof. dr Mirjana Doknić skeletal system, metabolic status, and improvement
of the quality of life. GH replacement in adults returns
Klinika za endokrinologiju dijabetes i bolesti metabolizma,
Univerzitetski klinički centar Srbije, Dr Subotića 13, Beograd, the mortality rate to that expected for age in the
Srbija general population. Due to the known proliferative,
mirjanadoknic@gmail.com angiogenic, and anti-apoptotic properties of GH,
there is still some caution regarding the recurrence
of hypopituitarism-causing tumors or the appearance
of new tumors during GH replacement. However,
Abstract large and long-term follow-up studies of adults on

Growth hormone deficiency (GHD) in adults is a rare GH therapy have shown a high safety profile of this
clinical syndrome with an incidence of 1.4–4.2 per treatment. Daily injections of GH were until recently
100,000 persons per year and a prevalence of 350/ the only way of its application, and now long-acting
million. It is characterized by unfavorable body weekly forms have been marketed, which will
composition, reduced muscle, and bone mass, lower significantly improve adherence to this therapy.
capacity to endure physical effort, abnormal lipid Keywords: growth hormone deficiency in adults,
profile, increased cardiovascular risk and poor quality growth hormone replacement in adults, transition
of life. Despite these clinical manifestations, GHD is
often unrecognized, so its diagnosis is often missed
or delayed. The reason is the non-specific and subtle
clinical characteristics, which require the testing of Introduction
growth hormone (GH) secretion with stimulation tests. Adult growth hormone deficiency (GHD) is a well-defined
Two tests are in use, the insulin tolerance test and the clinical phenomenon characterized by unfavorable body
glucagon test, which require the experience of the composition, reduced bone mineral density (BMD), glucose
team performing them. Recently, an oral secretagogue intolerance, poor lipid profile, increased cardiovascular risk,
of growth hormone - macimorelin has been used, and diminished quality of life . Patients with hypofunction
1
which is a simple test to perform and is safe for the of the anterior pituitary lobe, also known as hypopituitari-
patient. Insufficient secretion of GH in adults can be sm, which often includes GHD, have up to twice the mortali-
manifested as isolated or in combination with deficits ty rate compared to the general population of the same age
group . Adults with Growth Hormone Deficiency (AGHD) can
2
of other pituitary hormones. However, GH is the most be grouped into two categories: 1) patients in whom GHD
frequently detected hormonal deficit in adults as part originated in childhood and persists after growth completi-
of hypopituitarism. Causes of GHD can be congenital or on (Childhood Onset Growth Hormone Deficiency, COGHD),
acquired. Congenital reasons are the result of disorders and 2) patients who acquire GHD in adulthood (Adult Onset
of the embryogenic development of the pituitary gland Growth Hormone Deficiency, AOGHD). Causes of inadequ-
and hypothalamus, and acquired are the most common ate secretion or deficiency of growth hormone (GH) can be
3, 4
complications of tumors of the sellar region and head congenital (inherited) or acquired .
trauma. Patients with GHD have an increased mortality Congenital GHD is the result of congenital structural or
rate compared to the general population. The causes functional anomalies in the hypothalamic/pituitary region,
of the shortened life span of these patients depend on as well as documented mutations in genes crucial to the
the etiology of hypopituitarism, the applied therapy of embryonic development of this region. Given their com-
tumors of the hypothalamus/pituitary region (surgery, mon embryonic origin, structural/developmental anomalies

REVIEW PAPER Galenika Medical Journal, 2024; 3(9):19-25. 19