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hip circumference, subcutaneous fat thickness, bone den- Adverse effects and contraindications
sity, and fat quantity measured by the DXA method) and of growth hormone therapy
QoL are monitored at specific intervals. Once a stable GH
dose is established, patients should be monitored every 3 The adverse effects of GH administration are usually
to 6 months during the first year of therapy, and later on dose-dependent and transient, resolving with a reduction
every 6 to 12 months. The timing of subsequent follow-ups in GH dose. Lower initial GH doses and careful titration to
is determined based on the primary pituitary pathology and maintenance doses can prevent adverse effects. The most
other factors such as pituitary or brain radiation therapy. common adverse effects are edema and arthralgia (due to
Adverse effects of GH therapy are monitored, including fluid fluid retention from the antinatriuretic effect of GH). Due
retention, glycemic dysregulation, and the potential for de to the anti-insulin effect of growth hormone, there is a
novo tumor occurrence or growth of the residual pituitary trend towards increased blood glucose and insulin levels.
tumor causing GHD. Potential interactions of GH with other However, these changes are mild and are related to the first
hormones are also assessed. Growth hormone stimulates months of therapy; afterward, these parameters return to
the peripheral conversion of T4 to T3, which may lead to baseline values and there is an improvement in long-term
decreased levels of free thyroxine (FT4). Measurements of glycemic control due to changes in body composition (redu-
serum FT4 concentrations are necessary during GH substi- ction in abdominal fat). Long-term studies monitoring the
tution therapy to adjust the dose of thyroxine if it is part of effects of GH therapy on over 15,000 patients show that the
the therapy or to initiate thyroxine substitution in case of risk of developing diabetes mellitus (DM) is slightly increa-
unmasked secondary hypothyroidism . Growth hormone sed, with older individuals and those with higher BMI and
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accelerates cortisol metabolism, which may necessitate an poor lipid profiles being more predisposed 23, 30 . Contraindi-
increase in hydrocortisone dose if it is part of the therapy or cations for GH therapy include: active malignant disease,
the introduction of hydrocortisone due to the manifestation manifest diabetes mellitus, severe liver and kidney diseases,
of secondary hypocortisolism. If GH therapy is effective, the- benign intracranial hypertension, and severe psychiatric di-
re is no reason for it to be discontinued until advanced age. sorders.
Before initiating GH therapy, special caution should be
exercised in patients who have undergone surgery or ra- Use of growth hormone during
diation therapy for endocrine tumors or have a history of the transition period
malignancy. Due to the mitogenic effect of GH, there has
been ongoing debate about the risk of primary tumor recu- The transition period (TP) represents a stage in an indivi-
rrence or the development of secondary neoplasms practi- dual's life that begins in late puberty and ends with comple-
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cally since the beginning of its use in patients with GHD . te physical and psychosocial maturation into adulthood .
27
Aggregate data from large studies and long-term follow-up The transition lasts for six to seven years after the completi-
of individuals with AGHD on GH therapy have shown that on of growth or reaching final adult height. During this pe-
there is no increased risk of tumor recurrence or de novo tu- riod, it is necessary to consider the need for continuing GH
mor development associated with GHD causative tumors . therapy in individuals who had growth hormone deficiency
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The appropriate selection of patients for GH replacement (COGHD) during childhood. Patients with other reasons for
therapy and the optimal dose of this hormone ensure the short stature during childhood should not be treated with
safety of treatment. For young adults in the transition pe- growth hormone in adulthood (idiopathic GHD, Turner syn-
riod (18-25 years of age), at least two years of remission of drome, Noonan syndrome, Prader-Willi syndrome, chronic
the underlying disease (stable size of the tumor residue on renal insufficiency, small for gestational age). Due to the
MRI) should pass before starting GH therapy. For those ol- physical, metabolic, psychological, and social specificities
der than 25 years, this period may be longer, and if the indi- generally associated with the transition from adolescence
vidual had adult-onset malignancy, at least five years of di- to adulthood, patients with COGHD require special attenti-
sease remission are required before initiating GH therapy . on and collaboration between pediatricians and endocrino-
29
Clinical experience indicates that the safety of introducing logists, sometimes psychologists and gynecologists, as well
GH therapy is higher with a longer period of monitoring the as parents/guardians for better monitoring and treatment
31
stable size of the pituitary tumor residue. During the first of these individuals .
year of GH therapy, it is recommended to perform an MRI Achieving satisfactory height is only a prerequisite for
of the pituitary region every 6 months, and then annually to
every three years depending on the underlying pathology achieving normal body composition. In healthy individuals,
the TP period is precisely when there is a peak in muscle
and treatment (surgery, radiotherapy).
mass and bone density. When GH is deficient during this
period, it leads to a deterioration in body composition, cha-
racterized by a reduction in muscle mass and bone density,
increased fat tissue, and heightened cardiovascular risk.
The goal of GH therapy during the transition is to achieve

REVIEW PAPER Galenika Medical Journal, 2024; 3(9):19-25. 23