THERAPY OF ENDOCRINE DISEASE: Growth hormone replacement therapy in adults: 30 years of personal clinical experience

TY - JOUR

T1 - THERAPY OF ENDOCRINE DISEASE

T2 - Growth hormone replacement therapy in adults: 30 years of personal clinical experience

AU - Jørgensen, Jens O L

AU - Juul, Anders

N1 - © 2018 European Society of Endocrinology.

PY - 2018

Y1 - 2018

N2 - The acute metabolic actions of purified human growth hormone (GH) were first documented in adult hypopituitary patients more than 50 years ago, and placebo-controlled long-term GH trials in GH-deficient adults (GHDA) surfaced in 1989 with the availability of biosynthetic human GH. Untreated GHDA is associated with excess morbidity and mortality from cardiovascular disease and the phenotype includes fatigue, reduced aerobic exercise capacity, abdominal obesity, reduced lean body mass, osteopenia and elevated levels of circulating cardiovascular biomarkers. Several of these features reverse and normalize with GH replacement. It remains controversial whether quality of life, assessed by questionnaires, improves. The known side effects are fluid retention and insulin resistance, which are reversible and dose dependent. The dose requirement declines markedly with age and is higher in women. Continuation of GH replacement into adulthood in patients with childhood-onset disease is indicated, if the diagnosis is reconfirmed. GH treatment of frail elderly subjects without documented pituitary disease remains unwarranted. Observational data show that mortality in GH-replaced patients is reduced compared to untreated patients. Even though this reduced mortality could be due to selection bias, GH replacement in GHDA has proven beneficial and safe.

AB - The acute metabolic actions of purified human growth hormone (GH) were first documented in adult hypopituitary patients more than 50 years ago, and placebo-controlled long-term GH trials in GH-deficient adults (GHDA) surfaced in 1989 with the availability of biosynthetic human GH. Untreated GHDA is associated with excess morbidity and mortality from cardiovascular disease and the phenotype includes fatigue, reduced aerobic exercise capacity, abdominal obesity, reduced lean body mass, osteopenia and elevated levels of circulating cardiovascular biomarkers. Several of these features reverse and normalize with GH replacement. It remains controversial whether quality of life, assessed by questionnaires, improves. The known side effects are fluid retention and insulin resistance, which are reversible and dose dependent. The dose requirement declines markedly with age and is higher in women. Continuation of GH replacement into adulthood in patients with childhood-onset disease is indicated, if the diagnosis is reconfirmed. GH treatment of frail elderly subjects without documented pituitary disease remains unwarranted. Observational data show that mortality in GH-replaced patients is reduced compared to untreated patients. Even though this reduced mortality could be due to selection bias, GH replacement in GHDA has proven beneficial and safe.

KW - Body Composition

KW - Bone Diseases, Metabolic/etiology

KW - Exercise Tolerance

KW - Hormone Replacement Therapy

KW - Human Growth Hormone/deficiency

KW - Humans

KW - Hypopituitarism/complications

KW - Insulin Resistance

KW - Obesity, Abdominal/etiology

KW - Quality of Life

KW - Recombinant Proteins/therapeutic use

KW - Treatment Outcome

KW - Water-Electrolyte Imbalance/chemically induced

U2 - 10.1530/eje-18-0306

DO - 10.1530/eje-18-0306

M3 - Review

C2 - 29716978

SN - 0804-4643

VL - 179

SP - R47-R56

JO - European Journal of Endocrinology

JF - European Journal of Endocrinology

IS - 1

ER -