Growth Hormone Deficiency

Growth hormone deficiency can occur for a variety of reasons, either in isolation or part of panhypopituitarism (a deficiency of all pituitary hormones). The cells of the pituitary gland that produce growth hormone (somatotrophic cells) are very sensitive to trauma, radiation, and compression. Isolated growth hormone deficiency has been reported after closed head injury, and growth hormone is one of the first hormones to be depressed by compression of the pituitary gland from a mass lesion.

Symptoms

In children, growth hormone deficiency can lead to short stature and delay in puberty, and it is the most common symptom in children with pituitary lesions. Recently, growth hormone deficiency syndrome in adults has been recognized. Symptoms include decreased energy, a feeling of social isolation, and an increase in fat and decrease in lean muscle mass. Patients have poor exercise tolerance. Osteoporosis is common.

Treatment

Synthetic growth hormone has improved treatment of growth hormone deficiency. There is no oral replacement therapy and thus treatment requires daily injections. In children, growth hormone replacement is critical for growth and development. In adults, replacement therapy has been controversial but is now widely accepted. Most patients who start treatment are hesitant to stop it due to perceived benefits. For patients with normal IGF-1 levels, there may not be any benefit from growth hormone therapy. For patients with diminished IGF-1, growth hormone can be titrated to normalize IGF-1 and the benefits usually are noted in six to 18 months.