GH Replacement in the Elderly: Is It Worth It?

Abstract

Growth hormone (GH), once the age of linear growth is completed, continues to play a fundamental role for the human body. In adulthood, GH contributes to regulate muscle, cardiovascular and bone metabolism. The same happens in old age, although there is less data on the effect of GH in the elderly. Regardless the age of onset, a reduced quality of life (QoL), an increased cardiovascular risk and an accelerated age-related decline in physical strength have been demonstrated in the elderly with GH deficiency (EGHD). In adults with GH deficiency (AGHD), recent studies suggest a role of GH replacement therapy (GHrt) in improving lean/fat mass ratio, blood pressure, lipid profile, bone metabolism and QoL. Despite these recent studies, there is still a lack of randomized controlled trials proving these positive effects in EGHD. Moreover, the lack of a long-term positive outcome on mortality, and the cost of GHrt could often impact on treatment decision-making and lead to postpone or avoid the prescription. The aim of this mini-review is to summarize the available data on GHrt in EGHD, in order to highlight its weaknesses and strengths and to provide directions to clinicians that will help in the management of this specific set of patients.

Treating Hypopituitarism in the Over 65s: Review of Clinical Studies

“… 129 Doses between 0.2 mg/day and 0.33 mg/day are in general able to maintain IGF-1 levels in this range. 130 , 131 Fasting glucose, hemoglobin A1C levels, lipid profile, BMI, waist circumference and waist-to-hip ratio should be monitored. Even if studies revising the safety of the long-term therapy with rGH did not show an increased incidence of cancer, 132 the presence of an active neoplasia contraindicates the use of the rGH.…”

The evolving continuum of dysglycaemia: Non‐diabetic hyperglycaemia in older adults

“…It is well recognised that growth hormone levels decline with age, but treatment with growth hormone does not confer the benefits that might be expected in younger adults. 49 Similarly, testosterone levels in men are known to decline with age, yet replacement even in men with symptoms consistent with deficiency, provides minimal benefit, while exposure to the potential side effects remain. 50…”

“…There is precedence within the endocrine system for such a relationship between declines in hormone levels associated with healthy ageing (as opposed to those with recognised hormone deficiencies), and benefits of hormone replacement. It is well recognised that growth hormone levels decline with age, but treatment with growth hormone does not confer the benefits that might be expected in younger adults 49 . Similarly, testosterone levels in men are known to decline with age, yet replacement testosterone, even in men with symptoms consistent with testosterone deficiency, provides minimal benefit, while exposure to the potential side effects remain 50 …”

Age-Related Hormones Changes and Its Impact on Health Status and Lifespan

“…In the last decade a considerable number of publications have tried to overcome this lack of information and have focused in enhancing a better characterization [ 132 ] of certain endocrine diseases [ 133 - 136 ], and their treatment options [ 137 - 139 ] in relation to age-related changes [ 140 ]. Very prevalent disorders at young-mid ages show an important increase in their prevalence with aging; of particular note for general physicians, geriatricians and also endocrinologists are type 2 diabetes, with a prevalence >25% ( www.diabetes.org/resources/statistics/statistics-about-diabete ), obesity and metabolic syndrome [ 141 ] which raises up to 50% and hypothyroidism which is present in about 5% of women older than 60 years [ 142 ].…”