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Document Details :
Title: Treatment of adult growth hormone deficiency: who, why and how? A review.
Author(s): ALEXOPOULOU O, ABS R, MAITER D
Journal: Acta Clinica Belgica
Volume: 65 Issue: 1 Date: 2010
Adult growth hormone defi ciency (AGHD) is nowadays recognized as a distinct clinical entity and replacement therapy has become a standard practice. Refl ecting on the accumulated evidence, questions nevertheless arise. Should all AGHD patients be treated? What dose of GH should be given and for how long? What are the real long-term benefi ts, in particular regarding life expectancy? If the diagnosis of severe GHD is firmly established and if there is no contra-indication (such as an active cancer or uncontrolled diabetes), it is worthwile initiating GH replacement therapy. Treatment can indeed correct the abnormal body composition, improve various adverse cardiovascular parameters and risk factors, increase muscle strength and bone mineral density and, although to a variable degree, improve the patient’s quality of life and psychological well-being. Treatment should be started with very low doses to avoid side-effects related to fl uid retention and should then be gradually titrated against IGF-I values, clinical response and individual tolerance. There is unfortunately no confirmed predictive factor for the overall therapeutic response in a given individual. Thus, the decision to whether or not pursue the therapy will depend on the ratio of perceived and expected benefi ts over cost and risks of treatment, as well as on the persistent motivation of the patient.