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Growth hormone deficiency and replacement in adults

BMJ 1996; 313 doi: (Published 10 August 1996) Cite this as: BMJ 1996;313:314
  1. Stephen M Shalet
  1. Professor of medicine Department of Endocrinology, Christie Hospital NHS Trust, Manchester M20 4BX

    Useful in those with reduced quality of life or bone mineral densitye

    Evidence gathered over the past 10 years indicates that growth hormone deficiency in adults is associated with adverse changes in body composition, lipid profile, insulin status, physical performance, bone mineral density, and quality of life. Furthermore, randomised placebo controlled studies indicate that, to varying degrees, growth hormone replacement therapy can reverse these biological changes. Experience has shown that the optimal replacement dose of growth hormone in adults is not only substantially lower than the dose in children but also lower than the dose chosen for the early studies of adult growth hormone replacement. Thus, in future, side effects should be rare.1 2 Recently in many European countries including Britain, adult growth hormone deficiency has become a licensed indication for treatment. However, health economics dictate that we should select those patients most likely to benefit rather than giving a blanket prescription for all. What then are the indications for treatment?

    A major problem has been the non-specific nature of the clinical features experienced by patients with growth hormone deficiency, including obesity, mild depression, and fatigue. Greater public awareness of the beneficial effects of replacement may lead to patients with “media onset growth hormone …

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