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About Human Growth Hormone/HGH//Somatropin
HGH - Should treatment be continued in adult life?
Aimaretti G, Corneli G, Bellone S, Baffoni C, Camanni F, Ghigo
E.
Department of Internal Medicine, University of Turin, Italy.
Adults with growth hormone (GH) deficiency (GHD) have impaired health,
which improves with GH replacement. GHD in adulthood leads to impairment
in body composition and structure functions as well as to deranged
lipoprotein and carbohydrate metabolism leading to increased cardiovascular
morbidity. Therefore the transition adolescent in whom severe GHD
is confirmed has to continue GH replacement with an appropriate age-related
dosage. All short children who have been treated with rhGH for classical
and non-classical GHD should be suspected as potentially GHD in adulthood
though only in classical organic and idiopathic forms is severe GHD
likely to be confirmed. GHD must be shown biochemically by single
provocative testing. Insulin-induced hypoglycemia (ITT) and GHRH +
arginine are the tests of choice provided that appropriate cutoff
limits are assumed; these tests show good specificity and sensitivity.
Testing with GHRH + GH secretagogues is another reliable alternative.
Low IGF-I levels can be definitive evidence of persistent severe GHD
in patients with genetic GHD or panhypopituitarism, but normal IGF-I
levels do not rule out severe GHD. Individual titration of the rhGH
dose is recommended and measurement of IGF-I levels is needed for
monitoring the adequacy of replacement. The mean GH dose for replacement
in the transition adolescent, however, is still higher than in adulthood;
after puberty the rhGH dose should be progressively decreased in the
following years (probably up to 25 years old) in order to obtain optimal
peak bone mass. |
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