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Growth hormone deficiency

Growth hormone deficiency is the medical condition of inadequate production of growth hormone (GH) and its effects on children and adults. Growth hormone, also called somatotropin, is a polypeptide hormone which stimulates growth and cell reproduction. See separate articles on GH physiology and GH treatment. more...

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Deficiency of GH produces significantly different problems at various ages. In newborn infants the primary manifestations may be hypoglycemia or micropenis. In later infancy and childhood, growth failure may be major effect. Adults with growth hormone deficiency may have diminished lean body mass and poor bone density and a number of physical and psychological symptoms.

GH deficiency can be congenital or acquired in childhood or adult life. It can be partial or complete. It is usually permanent, but sometimes transient. It may be an isolated deficiency or occur in association with deficiencies of other pituitary hormones.

GH deficiency is treated by growth hormone replacement.


The term hypopituitarism is often used interchangeably with GH deficiency by endocrinologists but more often denotes GH deficiency plus deficiency of at least one other anterior pituitary hormone. When GH deficiency (usually with other anterior pituitary deficiencies) is associated with posterior pituitary hormone deficiency (usually diabetes insipidus) the condition is termed panhypopituitarism.

HGH also refers to human growth hormone but this older abbreviation has begun to develop paradoxical connotations (see fuller discussion of HGH in GH treatment and HGH quackery).

Causes of GH deficiency

There are many causes of GH deficiency. Some examples include:

  • mutations of specific genes (e.g., GHRHR, GH1)
  • congenital malformations involving the pituitary (e.g., septo-optic dysplasia, posterior pituitary ectopia)
  • damage to the pituitary from incracranial disease (e.g., hydrocephalus),
  • intracranial tumors in or near the sella turcica, especially craniopharyngioma,
  • damage to the pituitary from radiation therapy to the head for leukemia or brain tumors,
  • surgery in the area of the pituitary,
  • autoimmune inflammation (hypophysitis),
  • severe head trauma,
  • ischemic or hemorrhagic infarction from low blood pressure (Sheehan syndrome) or hemorrhage pituitary apoplexy.

Many cases of isolated growth hormone deficiency (IGHD) recognized in childhood are idiopathic. IGHD has been reported to affect about 1 in 4000 children, but IGHD is difficult to distinguish from other causes of shortness such as constitutional delay, and the true incidence is unsettled.

Severe prenatal deficiency of GH, as occurs in congenital hypopituitarism, has little effect on fetal growth. However, prenatal and congenital deficiency can reduce the size of a male's penis, especially when gonadotropins are also deficient. Besides micropenis, additional consequences of severe deficiency in the first days of life can include hypoglycemia and exaggerated jaundice (both direct and indirect hyperbilirubinemia). Female infants will lack the microphallus of course but may suffer from hypoglycemia and jaundice.


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Are we ready for growth hormone therapy in adults? - Tips from Other Journals
From American Family Physician, 11/15/02 by Richard Sadovsky

Human growth hormone is now readily available, thanks to recombinant DNA technology. Growth hormone therapy is being advocated by some physicians for adults with growth deficiency. To determine the validity of this treatment, the following four questions must be addressed: (1) Does a growth hormone deficiency syndrome in adults exist? (2) Does growth hormone deficiency actually cause the signs and symptoms of this syndrome? (3) Is growth hormone safe and does it reduce morbidity and mortality from this syndrome? (4) Is growth hormone treatment cost-effective? Isley reviewed the current knowledge about growth hormone deficiency syndrome in adults and offers thoughts about the questions involved in adult therapy.

Hypopituitarism has been associated with increased mortality, especially from cardiovascular disease. Patients with growth hormone deficiency syndrome generally have increased fat mass and decreased lean body mass. Insulin resistance, dyslipidemia, and other factors associated with increased atherogenesis have also been associated with this syndrome. Thus, a clinical growth hormone deficiency syndrome does seem to exist. It is less clear whether this syndrome is specifically due to growth hormone deficiency or results from hypopituitarism generally. Other hormonal deficiencies and hormone replacement issues may have an impact on this syndrome and increased resultant mortality. Overtreatment of multiple hormonal imbalances can cause central obesity and atherogenic and metabolic abnormalities. It is premature to conclude that growth hormone deficiency alone is responsible for growth hormone deficiency syndrome.

Growth hormone treatment can improve body mass composition when concomitant hormone deficiencies are also treated. Observed improvements in triglyceride and high-density lipoprotein levels have been less consistent. Improved survival and long-term safety of prolonged growth hormone therapy have yet to be studied. Many of the other positive results of growth hormone treatment can be achieved with conventional methods, including statins, antiplatelet therapy, and angiotensin-converting enzyme inhibitors. Altered body composition might be more cost-effectively achieved through supervised exercise training.

The author concludes that although growth hormone deficiency syndrome probably exists, it is uncertain that growth hormone deficiency is primarily the cause of the syndrome. Further studies are needed to determine the safety of treatment and whether more cost-effective approaches to the treatment of this syndrome can be identified.

In a related article in the same journal, Cook discusses the positive value of growth hormone treatment for hypopituitarism in improving bone density and the immune system, enhancing quality of life, and improving exercise tolerance. Effort on the part of the physician is required to determine testing, dosing, and monitoring guidelines for growth hormone therapy.

In an editorial in the same journal, Frohman points out some of the remaining questions and encourages further long-term research on the efficacy of growth hormone supplementation in reducing morbidity and mortality. He concludes that growth hormone therapy is probably indicated for use in patients with severe growth hormone deficiency, but other treatments may initially be more appropriate for use in patients with less severe signs and symptoms.

COPYRIGHT 2002 American Academy of Family Physicians
COPYRIGHT 2002 Gale Group

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