Consensus Guidelines for the Diagnosis and Treatment of Adults with Growth Hormone Deficiency: Summary Statement of the Growth Hormone Research Society Workshop on Adult Growth Hormone Deficiency

Attanasio, A.; Attie, Kenneth M.; Baxter, Robert C.; Bengtsson, Bengt‐Åke; Am, Black; Blethen, Sandra L.; Carlsson, Lena; Casaneuva, Felipe; Chipman, John J.; Christiansen, Jens Sandahl; Clemmons, David R.; Cuneo, Ross C.; Rijdt, D. De; Ghigo, Ezio; Hartman, Mark L.; Hernberg-Ståhl, Elisabeth; Hintz, R; Garvan, K. H.; Hoffman, David; Irie, Minoru; Jørgensen, Jens Otto Lunde; Kappelgaard, Anne-Marie; Laron, Zvi; Malozowski, Saúl; Russel‐Jones, David L.; Shalet, SM; Sizonenko, P; Sönksen, P. H.; Strasburger, Christian J.; Takano, Kazue; Thorner, M. O.

doi:10.1210/jc.83.2.379

Cited by 401 publications

(96 citation statements)

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“…; however, in some patients, IGF1 concentration was between K1 and K2 S.D. A normal IGF1 level does not rule out GHD in patients with a high probability of GHD (4,11,13,18). Since all patients suffered from evident hypothalamic-pituitary disease and peak GH response to provocative testing was below the cut-off for the specific provocative test used, all patients were considered to be with severe GHD.…”

Section: Discussionmentioning

confidence: 99%

“…For ITT, a peak GH response of !3 mg/l (!9 mU/l) was used to diagnose severe GHD (11,14,23). For the GHRH-arginine test, a peak GH response of !9 mg/l (!27 mU/l) was used as cut-off value (24).…”

Section: Methodsmentioning

confidence: 99%

“…Severe GHD is defined according to the consensus guidelines of the GH Research Society for the diagnosis and treatment of adults with GHD, published in 1997 (11). Thereafter, these guidelines have been reviewed and updated a number of times (2,(12)(13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

“…The combined GHRH-arginine test is a good alternative if ITT is contraindicated, although the latter may be misleading in an early stage in patients with GHD of hypothalamic origin (11,14,16). When two or more pituitary deficiencies are present and insulin-like growth factor 1 (IGF1) level is below the lower reference range for age and gender, GHD can be assumed, since the probability of severe GHD increases with an increasing number of pituitary hormone deficits (11,(17)(18)(19). Therefore, these patients do not require further testing (17,18).…”

Section: Introductionmentioning

confidence: 99%

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Dutch National Registry of GH Treatment in Adults: patient characteristics and diagnostic test procedures

Nieuwpoort

Bunderen

Arwert

et al. 2011

European Journal of Endocrinology

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Objective: The Dutch National Registry of GH Treatment in Adults was established in 1998 as an initiative of the Ministry of Health. The main goals were to gain more insight into long-term efficacy, safety, and costs of GH therapy (GHT) in adult GH-deficient (GHD) patients in The Netherlands. Methods: Baseline patient characteristics and diagnostic test procedures were evaluated. Results: Until January 2009 in roughly 10 years, 2891 patients (1475 men and 1416 women, mean age 43.5G16.5 years) were registered. GHD was of childhood-onset (CO) in over 20% of the patients and of isolated in 11%. The most common causes of GHD were pituitary tumors and/or their treatment, craniopharyngiomas, and idiopathic GHD. In 85% of the patients, a GH stimulation test was performed, in the majority an insulin tolerance test (ITT) (49%) or a combined GHRH-arginine test (25%). In 12% of the patients, IGF1 levels were %K2 S.D. combined with two or more additional pituitary hormone deficits, and in 2%, it concerned patients with CO-GHD continuing GHT in adulthood. Over the years, the test of first choice shifted from ITT toward GHRH-arginine test. Conclusion: Nearly, 2900 patients were included in the nationwide surveillance database of the Dutch National Registry of GH Treatment in Adults until January 2009. Baseline patient characteristics are comparable to that reported previously. In 85% of these patients, the diagnosis of GHD was established by provocative testing, particularly an ITT or a combined GHRH-arginine test, with an evident increase in the percentage of GHRH-arginine tests being performed in the last years.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Dutch National Registry of GH Treatment in Adults: patient characteristics and diagnostic test procedures

Nieuwpoort

Bunderen

Arwert

et al. 2011

European Journal of Endocrinology

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“…The four estimates consisted of the peak GH response to an insulin tolerance test (ITT), 24-h GH profile, basal IGF1 and IGFBP3; the greatest discrimination was achieved with the peak GH response to an ITT, whereby no patient achieved a peak GH response O3 ng/ml and no control a response !5 ng/ml. Throughout the article Hoffman et al (14) referred only to GHD; it was only later that their biochemical threshold of a peak GH response of 3 ng/ml was adopted by formal guidelines (15), and quite casually used to define severe GHD as opposed to the broader term GHD which encompasses all degrees of GHD. Pursuing that point further, it is important to appreciate that the vast majority of hypopituitary patients, studied by Hoffman et al (14), had multiple pituitary hormone deficiencies (MPHD).…”

Section: Definition Of Ghdmentioning

confidence: 99%

EXTENSIVE EXPERTISE IN ENDOCRINOLOGY: UK stance on adult GH replacement: the economist vs the endocrinologist

Shalet

2013

European Journal of Endocrinology

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In the UK, through the use of a forced economic model, endocrinologists are in the curious position of offering GH replacement to some patients with severe GH deficiency (GHD) but withholding it from other patients with even more severe GHD. This approach is counter-intuitive to endocrine practice in treating endocrine deficiency states. For all other endocrine deficiencies, one would opt for treating those with the most severe biochemical evidence of deficiency first. If this endocrine approach was applied to adult GH replacement in an era of rationing, one would start with the GHD patients with a pathologically low IGF1 level. Given that the prevalence of subnormal IGF1 levels in a GHD population is age-dependent, this would result in GH replacement being offered to more young adult onset (AO) GHD and childhood onset GHD adults, and less often to middle-aged and elderly AO GHD adults. This in itself has the added advantage that the skeletal benefits appear more real in the former cohort of patients.

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Hormone Replacement Therapy

Janssen

Lely

Rogol

et al. 2013

Pituitary Disorders

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vaccinationists, it is important to understand that they have deeply held beliefs, often of a spiritual or philosophical nature, 11 and these beliefs have remained remarkably constant over the better part of two centuries. The movement encompasses a wide range of individuals, from a few who express conspiracy theories, to educated, well informed consumers of health care, who often have a complex rationale for their beliefs, related to a "mixture of world views held about the environment, healing, holism. .. and a critical reading of the scientific and alternative literature." 12 Vaccination is unique among de facto mandatory requirements in the modern era, requiring individuals to accept the injection of a medicine or medicinal agent into their bodies, and it has provoked a spirited opposition. This opposition began with the first vaccinations, has not ceased, and probably never will. From this realisation arises a difficult issue: how should the mainstream medical authorities approach the anti-vaccination movement? A passive reaction could be construed as endangering the health of society, whereas a heavy handed approach can threaten the values of individual liberty and freedom of expression that we cherish. This creative tension will not leave us and cannot be cured by force alone.

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Consensus Guidelines for the Diagnosis and Treatment of Adults with Growth Hormone Deficiency: Summary Statement of the Growth Hormone Research Society Workshop on Adult Growth Hormone Deficiency

Cited by 401 publications

References 0 publications

Dutch National Registry of GH Treatment in Adults: patient characteristics and diagnostic test procedures

Dutch National Registry of GH Treatment in Adults: patient characteristics and diagnostic test procedures

EXTENSIVE EXPERTISE IN ENDOCRINOLOGY: UK stance on adult GH replacement: the economist vs the endocrinologist

Hormone Replacement Therapy

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