Evaluation and Treatment of Adult Growth Hormone Deficiency: An Endocrine Society Clinical Practice Guideline

Molitch, Mark E.; Clemmons, David R.; Malozowski, Saúl; Merriam, George R.; Vance, Mary Lee

doi:10.1210/jc.2011-0179

Cited by 728 publications

(502 citation statements)

References 204 publications

Supporting

Mentioning

472

Contrasting

Unclassified

Order By: Relevance

“…At baseline the diagnosis of GHD was established by the criteria of the Endocrine Society [18]. GHRH plus arginine test was performed in all subjects.…”

Section: Methodsmentioning

confidence: 99%

The visceral adiposity index is associated with insulin sensitivity and IGF-I levels in adults with growth hormone deficiency

2016

View full text Add to dashboard Cite

The visceral adiposity index, based on anthropometric and metabolic parameters, has been shown to be related to adipose tissue function and insulin sensitivity. We aimed to evaluate the performance of the visceral adiposity index in adult patients with growth hormone deficiency. We enrolled 52 patients(mean age 51 ± 13 years) with newly diagnosed growth hormone deficiency and 50 matched healthy subjects as controls at baseline. At baseline and after 12 and 24 months of treatment we evaluated anthropometric measures, lipid profile, glucose and insulin during an oral glucose tolerance test, hemoglobin A1c, homeostasis model assessment estimate of insulin resistance, quantitative insulin sensitivity check index, insulin sensitivity index Matsuda, insulin-like growth factor-I and visceral adiposity index. At baseline growth hormone deficiency patients showed higher waist circumference (p < 0.001), low-density lipoprotein cholesterol (p < 0.001) and visceral adiposity index (p = 0.003) with lower insulin sensitivity index (p = 0.007) and high-density lipoprotein cholesterol (p = 0.001) than controls. During growth hormone treatment we observed a significant increase in insulin-like growth factor-I (p < 0.001), high-density lipoprotein (p < 0.001) with a trend toward increase in insulin sensitivity index (p = 0.055) and a significant decrease in total cholesterol (p < 0.001) and visceral adiposity index (p < 0.001), while no significant changes were observed in other clinical and metabolic parameters. The visceral adiposity index was the only parameter that significantly correlated with growth hormone peak at diagnosis (p < 0.001) and with insulin-like growth factor-I and insulin sensitivity index both at diagnosis (p = 0.009 and p < 0.001) and after 12 (p = 0.026 and p = 0.001) and 24 months (p < 0.001 and p = 0.001) of treatment. The visceral adiposity index, which has shown to be associated with both insulin-like growth factor-I and insulin sensitivity, proved to be the most reliable index of metabolic perturbation, among the most common indexes of adiposity assessment and a marker of benefit during treatment in adult growth hormone deficiency patients.

show abstract

“…At baseline the diagnosis of GHD was established by the criteria of the Endocrine Society [18]. GHRH plus arginine test was performed in all subjects.…”

Section: Methodsmentioning

confidence: 99%

The visceral adiposity index is associated with insulin sensitivity and IGF-I levels in adults with growth hormone deficiency

2016

View full text Add to dashboard Cite

show abstract

“…Diagnosis of acromegaly was based on clinical criteria, unsuppressed GH in the oral glucose tolerance test, IGF-I elevation, and imaging or histologic proof of a somatotroph pituitary adenoma after surgery (2,14,15). Fourteen patients had GHD, either confirmed by a serum GH peak less than 5 μg/L after the insulin tolerance test (six patients) or strongly suggested by deficiencies in at least three other pituitary functions (4). Another 32 patients had other pituitary or endocrine disorders and were tested for suspected acromegaly or GHD.…”

Section: Study Populationmentioning

confidence: 99%

“…The Endocrine Society clinical practice guidelines for acromegaly, and the Acromegaly Consensus Group, recommend IGF-I measurements rather than random GH values for diagnosis and treatment goals (2,3). In patients with GHD, IGF-I is also crucial for monitoring GH replacement therapy and for adjusting the GH dosage (4).…”

Section: Introductionmentioning

confidence: 99%

Classification of Patients With GH Disorders May Vary According to the IGF-I Assay

Mavromati¹,

Kuhn

Agostini

et al. 2017

The Journal of Clinical Endocrinology &Amp; Metabolism

View full text Add to dashboard Cite

show abstract

“…[28][29][30] Consequently, BMI-adjusted cut points for GH stimulation testing test have been proposed and are currently recommended by several consensus guidelines. 31,32 Because of this known inverse relationship with BMI and peak GH after stimulation testing with glucagon, GHRH/arginine, and insulin tolerance testing, GHD was defined at 3 cut points, adjusted for BMI using a normal non-head-injured control cohort referred to the Dynamic Endocrine Testing Unit at the Oregon Health & Science University (Portland, OR) for assessment of possible GHD with low normal to low serum IGF-1 levels. 27,[33][34][35][36] From 119 men tested, individuals were excluded if they had a previous history of pituitary or hypothalamic tumor, other hypothalamic or pituitary disorder, pituitary surgery or irradiation, or TBI.…”

Section: Pituitary Hormonal Testingmentioning

confidence: 99%

Prevalence of Pituitary Hormone Dysfunction, Metabolic Syndrome, and Impaired Quality of Life in Retired Professional Football Players: A Prospective Study

Kelly

Chaloner

Evans

et al. 2014

Journal of Neurotrauma

View full text Add to dashboard Cite

Hypopituitarism is common after moderate and severe traumatic brain injury (TBI). Herein, we address the association between mild TBI (mTBI) and pituitary and metabolic function in retired football players. Retirees 30-65 years of age, with one or more years of National Football League (NFL) play and poor quality of life (QoL) based on Short Form 36 (SF-36) Mental Component Score (MCS) were prospectively enrolled. Pituitary hormonal and metabolic syndrome (MetS) testing was performed. Using a glucagon stimulation test, growth hormone deficiency (GHD) was defined with a standard cut point of 3 ng/mL and with a more stringent body mass index (BMI)-adjusted cut point. Subjects with and without hormonal deficiency (HD) were compared in terms of QoL, International Index of Erectile Function (IIEF) scores, metabolic parameters, and football career data. Of 74 subjects, 6 were excluded because of significant non-football-related TBIs. Of the remaining 68 subjects (mean age, 47.3 -10.2 years; median NFL years, 5; median NFL concussions, 3; mean BMI, 33.8 -6.0), 28 (41.2%) were GHD using a peak GH cutoff of < 3 ng/mL. However, with a BMI-adjusted definition of GHD, 13 of 68 (19.1%) were GHD. Using this BMI-adjusted definition, overall HD was found in 16 (23.5%) subjects: 10 (14.7%) with isolated GHD; 3 (4.4%) with isolated hypogonadism; and 3 (4.4%) with both GHD and hypogonadism. Subjects with HD had lower mean scores on the IIEF survey ( p = 0.016) and trended toward lower scores on the SF-36 MCS ( p = 0.113). MetS was present in 50% of subjects, including 5 of 6 (83%) with hypogonadism, and 29 of 62 (46.8%) without hypogonadism ( p = 0.087). Age, BMI, median years in NFL, games played, number of concussions, and acknowledged use of performance-enhancing steroids were similar between HD and non-HD groups. In summary, in this cohort of retired NFL players with poor QoL, 23.5% had HD, including 19% with GHD (using a BMI-adjusted definition), 9% with hypogonadism, and 50% had MetS. Although the cause of HD is unclear, these results suggest that GHD and hypogonadism may contribute to poor QoL, erectile dysfunction, and MetS in this population. Further study of pituitary function is warranted in athletes sustaining repetitive mTBI.

show abstract

Evaluation and Treatment of Adult Growth Hormone Deficiency: An Endocrine Society Clinical Practice Guideline

Cited by 728 publications

References 204 publications

The visceral adiposity index is associated with insulin sensitivity and IGF-I levels in adults with growth hormone deficiency

The visceral adiposity index is associated with insulin sensitivity and IGF-I levels in adults with growth hormone deficiency

Classification of Patients With GH Disorders May Vary According to the IGF-I Assay

Prevalence of Pituitary Hormone Dysfunction, Metabolic Syndrome, and Impaired Quality of Life in Retired Professional Football Players: A Prospective Study

Contact Info

Product

Resources

About