Consensus guidelines for the diagnosis and treatment of adults with GH deficiency II: a statement of the GH Research Society in association with the European Society for Pediatric Endocrinology, Lawson Wilkins Society, European Society of Endocrinology, Japan Endocrine Society, and Endocrine Society of Australia

Abstract

Objective: The GH Research Society held a Consensus Workshop in Sydney, Australia, 2007 to incorporate the important advances in the management of GH deficiency (GHD) in adults, which have taken place since the inaugural 1997 Consensus Workshop. Method: Two commissioned review papers, previously published Consensus Statements of the Society and key questions were circulated before the Workshop, which comprised a rigorous structure of review with breakout discussion groups. A writing group transcribed the summary group reports for drafting in a plenary forum on the last day. All participants were sent a polished draft for additional comments and gave signed approval to the final revision. Conclusion: Testing for GHD should be extended from hypothalamic-pituitary disease and cranial irradiation to include traumatic brain injury. Testing may indicate isolated GHD; however, idiopathic isolated GHD occurring de novo in the adult is not a recognized entity. The insulin tolerance test, combined administration of GHRH with arginine or growth hormone-releasing peptide, and glucagon are validated GH stimulation tests in the adult. A low IGF-I is a reliable diagnostic indicator of GHD in the presence of hypopituitarism, but a normal IGF-I does not rule out GHD. GH status should be reevaluated in the transition age for continued treatment to complete somatic development. Interaction of GH with other axes may influence thyroid, glucocorticoid, and sex hormone requirements. Response should be assessed clinically by monitoring biochemistry, body composition, and quality of life. There is no evidence that GH replacement increases the risk of tumor recurrence or de novo malignancy.

Genomewide meta‐analysis identifies loci associated with IGF ‐I and IGFBP ‐3 levels with impact on age‐related traits

“…Circulating IGF‐I is mainly bound to IGF‐binding proteins (IGFBPs) (Fowlkes, 1997), which affect activity (Lee et al ., 1997) and half‐life of IGF‐I (Guler et al ., 1989). From the clinical point of view, the measurement of IGF‐I and IGFBP‐3 blood concentrations is an important tool in establishing the diagnosis as well as monitoring treatment of GH‐related diseases (Ho & Participants, 2007; Cohen et al ., 2008; Melmed et al ., 2009). …”

Traumatic Brain Injury Causes Long-Term Reduction in Serum Growth Hormone and Persistent Astrocytosis in the Cortico-Hypothalamo-Pituitary Axis of Adult Male Rats

“…However, the reliability of serum IGF-1 as an indicator of GH deficiency is being debated (Aimaretti et al, 1998(Aimaretti et al, , 2003Granada et al, 2000). Specifically, the consensus guidelines for the diagnosis and treatment of adults with GH deficiency conclude that, ''a normal IGF-1 does not rule out GH deficiency'' (Ho, 2007). The guidelines also note that, ''as the GH axis may recover after TBI, testing for GHD should be undertaken no sooner than 12 months after the injury.''…”

The Case of Hypopituitarism in Traumatic Brain Injury

“…Most commonly basal morning cortisol concentrations are in-between, highly overlapping those of healthy subjects, and dynamic testing is therefore required eventually. At present, the ITT is considered the diagnostic gold standard (Ho, 2007). The test-retest reproducibility is higher than for GH (Vestergaard et al, 1997), but false abnormal results can be seen, in particular, if only borderline attainment of hypoglycaemia is achieved.…”

“…Part of this variation may be ascribed to diagnostic difficulties, including those caused by the stress of severe illness, but may also in some cases be related to medication effects, and lack of test re-test reproducibility. It is therefore often recommended that neuroendocrine evaluation should be performed no earlier than one year post trauma unless the clinical picture indicates otherwise Ho, 2007;Tanriverdi et al, 2011). Another important issue is which patients that should be considered for neuroendocrine evaluation.…”

“…Newer studies have, however, indicated otherwise, and overlooking the condition in case of the life-threatening adrenal insufficiency after brain trauma may be fatal (Schneider et al, 2007a). Thus, chronic anterior pituitary hormone deficits have been described with a higher frequency than previously anticipated and have caused expert panels to propose recommendations for routine assessment of pituitary function after TBI with appropriate replacement of insufficient axes Ho, 2007;Tanriverdi et al, 2011). Most populations have a high incidence of TBI of more than 100 in 100,000 inhabitants.…”