Page 22 - GALENIKA MEDICAL JOURNAL

of the pituitary and hypothalamus can be associated with unchanged throughout the day, but its level varies depen-
disruptions in brain and eye function and anatomy . Acqu- ding on age and gender.
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ired GHD is most commonly a result of pituitary and hypo-
thalamic tumors (non-functioning pituitary adenomas, cra-
niopharyngiomas, germinomas, Cushing's disease), cranial Diagnosis of adult growth
irradiation, head injuries, brain infections, vascular anoma- hormone deficiency (AGHD)
lies, and perinatal trauma. In cases where the cause of GHD
is unknown, with a normal magnetic resonance imaging Clinical diagnosis of AGHD
(MRI) scan of the pituitary region, it is referred to as idio- Diagnosis of GHD in adults is considered in all patients
pathic GHD.
with a history of hypothalamic-pituitary disease (primari-
The treatment with growth hormone in adults with con- ly tumors), cranial irradiation, childhood growth hormone
firmed GHD was approved in clinical practice in 1996 . Large deficiency, head trauma, subarachnoid hemorrhage, Shee-
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databases have confirmed numerous beneficial effects of han's syndrome, autoimmune pituitary diseases, those tre-
this therapy on body composition, skeletal system, cardio- ated for childhood malignancies, and patients with unclear
vascular system, metabolic status, and quality of life of pa- osteopenia. Clinical diagnosis of AGHD is not always stra-
tients, with a high safety profile. ightforward because there is no pathognomonic sign that
unequivocally indicates this condition, unlike in children
To date, articles addressing adult GH deficiency and its where short stature is a key diagnostic indicator of this
supplementation have not been published in domestic jour- condition . The manifestations of GHD are nonspecific and
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nals. Due to the clinical significance of this topic, it is essen- subtle. They result from the lack of the anabolic and lipolytic
tial for healthcare professionals at all levels to be familiar effects of GH, so patients have increased accumulation of
with this entity. To achieve this goal, this review paper was adipose tissue in the abdominal region, muscle weakness,
written, utilizing literature published over the past 15 years susceptibility to bone fractures, decreased physical activity
searched through databases such as PubMed, Scopus, and capacity, along various mental functioning problems such
Medline. The criteria for including studies in the analysis as depressive mood, insomnia, and forgetfulness (Table 1).
were as follows: original articles, review papers, randomized Unlike obesity, where there is an increase in fat deposits and
controlled clinical trials, open-label studies, non-interventi- muscle mass, in GHD, muscle mass is reduced. Epidemiolo-
onal follow-up studies, and data from registries of actual gical studies have shown that bone mass in AGHD is signi-
clinical practice. ficantly lower even when considering possible influences of
hypogonadism and excessive glucocorticoid substitution .
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Physiological role of growth hormone Table 1. Clinical signs and symptoms of GHD in adults
Clinical signs Symptoms
Unlike other hormones of the anterior pituitary, GH and Reduced muscle mass Poor quality of life
prolactin do not have exclusively one target organ or gland.
Most of GH's actions are mediated through a molecule ca- Increased fat mass (depression, forgetfulness, insomnia)
lled Insulin-like Growth Factor I (IGF-I). This biological me- Accelerated atherogenesis Abdominal obesity
diator of growth hormone is produced in the liver and then Poor lipid profile Osteoporosis and bone fractures
exerts endocrine effects by entering the bloodstream and Glucose intolerance Poor tolerance to physical exertion
reaching various organs. However, it is also locally produced Metabolic syndrome Rapid fatigue
in all tissues, exerting its paracrine and autocrine effects. Hypercoagulability Thromboses
IGF-I significantly opposes the effects of GH on fat metaboli- Coronary disease Reduced sweating
sm, carbohydrate metabolism, and insulin resistance, while
its effects on muscles and bones are very similar to those Table 2. Diagnosis of GHD in adults
of growth hormone. Pituitary GH secretion is regulated by Recommendations
hypothalamic hormones: it is stimulated by Growth Hormo- • hypothalamic-pituitary disease
ne Releasing Hormone (GHRH) and inhibited by somatosta- • history of cranial radiation
• anamnesis of COGHD
tin . Other stimulatory exogenous and endogenous factors Patients-candidates • disrupted structure of the pituitary gland
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(such as L-DOPA, kinidin, arginine, and ghrelin) can influen- for GHD testing • congenital anomalies of the pituitary gland
• genetic mutations
ce GH secretion. The regulation of GH secretion is controlled • deficiency of other pituitary hormones
by negative feedback via IGF-I at the level of the pituitary • Sheehan syndrome
• unclear osteopenia
and hypothalamus. GH is secreted in discrete pulses (se- • one test in those with hypothalamic-pituitary disease and
The number of
cretory episodes) throughout a 24 hours. Its secretion is in- provocative tests deficiency of one or more pituitary hormones
• two tests in those with isolated growth hormone deficiency.
fluenced by various factors such as age, gender, nutritional for assessing GH A provocative test is not necessary if all pituitary hormones are
status, stress, sleep, and certain pharmacological agents. In secretion missing (complete hypopituitarism) with low IGF-I levels
healthy individuals, the highest GH secretion occurs during Dynamic tests • insulin tolerance test (ITT)
deep sleep. The concentration of IGF-I remains relatively for assessing GH • glucagon stimulation test
secretion

20 DOI: 10.5937/Galmed2409023D