Warning: fopen(/home/virtual/enm-kes/journal/upload/ip_log/ip_log_2024-03.txt): failed to open stream: Permission denied in /home/virtual/lib/view_data.php on line 88 Warning: fwrite() expects parameter 1 to be resource, boolean given in /home/virtual/lib/view_data.php on line 89
1Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
2Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
3Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea
4Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
5Division of Endocrinology and Metabolism, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
6Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
7Division of Geriatrics, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
8Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
9Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
10Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
11Department of Endocrinology, Inha University School of Medicine, Incheon, Korea
12Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
13Department of Internal Medicine, National Cancer Center, Goyang, Korea
14Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
15Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
16Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
17Division of Endocrinology and Metabolism, Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
18Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju, Korea
19Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
20Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
21Division of Endocrinology, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
22Department of Internal Medicine, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
23Department of Endocrinology and Metabolism, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
24Division of Endocrinology, Department of Internal Medicine, Gachon University College of Medicine, Incheon, Korea
25Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
26Division of Endocrinology and Metabolism, Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea
Copyright © 2020 Korean Endocrine Society
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Diagnosis of growth hormone deficiency in adults
The insulin tolerance test is recommended as the standard test for diagnosing growth hormone (GH) deficiency (B).
When GH deficiency is suspected, but an insulin tolerance test is contraindicated, two or more GH stimulation tests (GH-releasing hormone—arginine, glucagon, levodopa, or clonidine stimulation tests) should be administered (B).
GH deficiency cannot be ruled out even if insulin-like growth factor-1 (IGF-1) levels are normal. However, low serum IGF-1 levels may be indicative of GH deficiency in individuals who do not have a history of poorly controlled diabetes, chronic liver disease, or treatment with oral contraceptives (C).
GH deficiency can be diagnosed without GH stimulation testing when the typical clinical characteristics of GH deficiency are present, accompanied by deficiencies in three or more pituitary hormones with low serum IGF-1 levels (B).
Repeated GH stimulation testing should be performed in patients with childhood-onset GH deficiency if they do not have a proven genetic cause of GH deficiency or irreversible damage (B).
Adult patients with irreversible pituitary damage should not receive repeated GH stimulation tests (B).
Treatment of growth hormone deficiency in adults
Unless contraindicated, GH therapy is recommended for patients with GH deficiency. GH therapy should start from a low dose, considering the patient’s age, sex, and estrogen levels (A).
Clinical improvements, side effects, and targeting serum IGF-1 levels within the age-adjusted reference range should be considered when adjusting the GH dose (A).
During the adjustment period, IGF-1 levels should be monitored monthly or bimonthly. Once the maintenance level is determined, IGF-1 levels should be monitored around twice per year. Monitoring should include an evaluation of the patient’s clinical response, side effects, and IGF-1 levels (B).
Diagnosis and treatment of growth hormone deficiency in children and adolescents
Two or more GH stimulation tests should be administered when GH deficiency is suspected in children (A).
Repeated GH stimulation tests are not required in GH patients with pituitary lesions or a proven genetic cause of GH deficiency (C).
GH replacement should be continued in children and adolescents until the epiphyseal plates close or their full height is reached (C).
GH replacement should be resumed as soon as possible in patients with GH deficiency during transition (B).
Benefits of growth hormone treatment
GH treatment improves body composition, exercise capacity, and bone mineral density in patients with GH deficiency (A).
GH treatment lowers the risk of cardiovascular disease in patients with GH deficiency, but there is insufficient evidence regarding its effects on mortality reduction (B).
GH treatment improves quality of life in patients with GH deficiency (A).
Risks and side effects of growth hormone treatment
GH treatment is contraindicated in patients with an active malignancy (except basal cell or squamous cell skin cancers) (A).
Changes in blood glucose levels should be observed during the course of GH treatment in patients with diabetes mellitus, who may require their antidiabetic medication to be adjusted (B).
Thyroid and adrenal gland function should be monitored during GH treatment in patients with hypopituitarism (B).
1.3. GH deficiency cannot be ruled out even if IGF-1 levels are normal. However, low serum IGF-1 levels may be indicative of GH deficiency in individuals who do not have a history of poorly controlled diabetes, chronic liver disease, or treatment with oral contracep-tives.
1.4. GH deficiency can be diagnosed without GH stimu-lation testing when the typical clinical characteristics of GH deficiency are present, accompanied by deficien-cies in three or more pituitary hormones with low se-rum IGF-1 levels.
1.5. Repeated GH stimulation testing should be per-formed in patients with childhood-onset GH deficiency if they do not have a proven genetic cause of GH defi-ciency or irreversible damage.
1.6. Adult patients with irreversible pituitary damage should not regularly receive repeated GH stimulation tests.
2.1. Unless contraindicated, GH therapy is recommended for patients with GH deficiency. GH therapy should start from a low dose, considering the patient’s age, sex, and estrogen levels.
2.2. Clinical improvements, side effects, and targeting se-rum IGF-1 levels within the age-adjusted reference range should be considered when adjusting the GH dose.
CONFLICTS OF INTEREST
No potential conflict of interest relevant to this article was reported.
AUTHOR CONTRIBUTIONS
Conception or design: J.H.K., H.W.C., S.O.C., C.R.K., C.H.K., E.J.L. Acquisition, analysis, or interpretation of data: J.H.K., H.W.C., S.O.C., C.R.K., C.H.K., E.J.L. Drafting the work or revising: J.H.K., H.W.C., S.O.C., C.R.K., K.H.P., D.J.L., K.J.K., J.S.L., G.K., Y.M.C., S.H.A., M.J.J., Y.H., J.H.L., B.K.K., Y.J.C., K.A.L., S.S.M., H.Y.A., H.S.C., S.M.H., D.Y.S., J.A.S., S.H.K., S.O., S.H.Y., B.J.K., C.H.S., S.W.K., C.H.K., E.J.L. Final approval of the manuscript: J.H.K., H.W.C., S.O.C., C.R.K., C.H.K., E.J.L.
Modified from Molitch et al. [1]; and Melmed [2], with permission from Massachusetts Medical Society.
PIT-1, pituitary transcription factor-1; PROP-1, prophet of pit-1; LHX3/4, LIM class homeobox transcription factor Lhx3, 4; HESX-1, homeobox-1; PITX-2, paired-like homeodomain transcription factor-2; GHRH, growth hormone-releasing hormone; GH, growth hormone.