Adult Human Growth Hormone Deficiency

Adult Human Growth Hormone Deficiency – Treatment Options

Introduction
Adult growth hormone deficiency (GHD) is a clinical syndrome resulting from inadequate secretion of growth hormone (GH) by the pituitary gland. It may occur due to pituitary tumors, surgery, radiotherapy, traumatic brain injury, or congenital causes. Adults with GHD present with decreased muscle mass, increased fat mass, reduced bone mineral density, fatigue, impaired exercise capacity, dyslipidemia, insulin resistance, and reduced quality of life. The primary goal of treatment is to restore GH levels to physiologic ranges, improve metabolic and physical health, and enhance overall well-being.

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1. Recombinant Human Growth Hormone (rhGH) Replacement

• Mainstay of therapy in adults with confirmed GHD.

• Administered as a daily subcutaneous injection, typically in the evening.

• Initial dose: 0.1–0.3 mg/day SC, adjusted individually based on age, sex, body composition, and clinical response.

• Titration: Dose increased gradually every 1–2 months, guided by clinical effects and serum insulin-like growth factor-1 (IGF-1) levels, aiming for mid-normal range for age and sex.

• Long-term benefits:

  • Increases lean body mass and decreases fat mass.

  • Improves bone density and reduces fracture risk.

  • Enhances exercise tolerance and cardiovascular profile.

  • Improves mood, cognitive function, and quality of life.

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2. Adjunctive and Supportive Management

• Lipid profile management: Statins may be prescribed for persistent dyslipidemia.

• Bone health: Adequate calcium and vitamin D supplementation; bisphosphonates if osteoporosis is significant.

• Cardiovascular risk factors: Lifestyle modifications (diet, exercise, weight control) and medications for hypertension or diabetes.

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3. Monitoring and Safety Considerations

• IGF-1 levels: Monitored every 6–12 weeks during dose titration, then every 6–12 months once stable.

• Adverse effects: Dose-related side effects include edema, arthralgia, carpal tunnel syndrome, paresthesias, and insulin resistance. Reducing dose often alleviates these symptoms.

• Metabolic monitoring: Regular checks of fasting glucose, HbA1c, lipids, and blood pressure.

• Long-term surveillance: Periodic MRI in patients with prior pituitary tumors to exclude recurrence or growth.

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4. Patient Education

• Importance of adherence to daily injections for maximum benefit.

• Recognition of side effects such as swelling, joint pain, or numbness in hands.

• Need for lifelong therapy in most cases, unless spontaneous recovery occurs (rare).

• Patients should be counseled on realistic expectations: improvements are gradual and become evident over months to years.