Growth Hormone Deficiency in Adults (Frontiers of Hormone Research)

241 Pages·2005·1.35 MB·English

by  Jens Otto Lunde Jorgensen

Growth Hormone Deficiency in Adults
Frontiers of Hormone Research
Vol.33
Series Editor
Ashley B. Grossman London
Growth Hormone
Deficiency in Adults
Volume Editors
Jens Otto Lunde Jørgensen Aarhus
Jens Sandahl Christiansen Aarhus
14 figures and 13 tables, 2005
Basel·Freiburg·Paris·London·New York·
Bangalore·Bangkok·Singapore·Tokyo·Sydney
Jens Otto Lunde Jørgensen,MD
Medical Department M
Aarhus University Hospital
Aarhus, Denmark
Jens Sandahl Christiansen,MD
Medical Department M
Aarhus University Hospital
Aarhus, Denmark
Library of Congress Cataloging-in-Publication Data
Growth hormone deficiency in adults / volume editors, Jens Otto Lunde
Jorgensen, Jens Sandahl Christiansen.
p. ; cm. – (Frontiers of hormone research, ISSN 0301-3073; v. 33)
Includes bibliographical references and index.
ISBN 3–8055–7992–6 (hard cover : alk. paper)
1. Dwarfism, Pituitary. 2. Somatotropin–Therapeutic use. 3. Growth
disorders.
[DNLM:1. Human Growth Hormone–deficiency–Adult. 2. Human Growth
Hormone–therapeutic use–Adult. 3. Hormone Replacement Therapy–Adult. 4.
Hypopituitarism–complications–Adult. 5.
Hypopituitarism–etiology–Adult. 6. Hypopituitarism–therapy–Adult. WK
550 G88398 2005] I. Jørgensen, Jens O. L. II. Christiansen, Jens Sandahl.
III. Series.
RC658.7.G77 2005
616.4(cid:1)7–dc22
2005018888
Bibliographic Indices. This publication is listed in bibliographic services.
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dosage set forth in this text are in accord with current recommendations and practice at the time of publication.
However, in view of ongoing research, changes in government regulations, and the constant flow of information
relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for
any change in indications and dosage and for added warnings and precautions. This is particularly important
when the recommended agent is a new and/or infrequently employed drug.
All rights reserved. No part of this publication may be translated into other languages, reproduced or
utilized in any form or by any means electronic or mechanical, including photocopying, recording, microcopying,
or by any information storage and retrieval system, without permission in writing from the publisher.
© Copyright 2005 by S. Karger AG, P.O. Box, CH–4009 Basel (Switzerland)
www.karger.com
Printed in Switzerland on acid-free paper by Reinhardt Druck, Basel
ISSN 0301–3073
ISBN 3–8055–7992–6
Contents
VII Foreword
Grossman, A.B. (London)
IX Preface
Jørgensen, J.O.L.; Christiansen, J.S. (Aarhus)
1 Clinical Aspects of Growth Hormone Deficiency in Adults.An Overview
Jørgensen, J.O.L.; Christiansen, J.S. (Aarhus)
21 Epidemiology of Adult Growth Hormone Deficiency.Prevalence,Incidence,
Mortality and Morbidity
Erfurth, E.M. (Lund)
33 Hypopituitarism following Traumatic Brain Injury
Popovic, V. (Belgrade); Aimaretti, G. (Turin);
Casanueva, F.F. (Santiago de Compostela); Ghigo, E. ( Turin)
45 IGF-I Measurements.Epidemiological and Clinical Aspects
Juul, A. (Copenhagen)
68 Diagnosis of Growth Hormone Deficiency
Fisker, S. (Aarhus); Andersen, M. (Odense); Ørskov, H. (Aarhus)
86 Clinical Monitoring of Growth Hormone Replacement in Adults
Gibney, J. (Dublin); Johannsson, G. (Gothenburg)
V
103 Consequences of Growth Hormone Deficiency for Intermediary
Metabolism and Effects of Replacement
Nørrelund, H. (Aarhus)
121 Skeletal and Cardiac Muscle in Adults with Growth Hormone Deficiency
Cuneo, R.C.; Wallace, J.D. (Brisbane)
146 Bone Metabolism and Growth Hormone Deficiency.Experimental and Clinical
Aspects
Ueland, T.; Bollerslev, J. (Oslo)
161 Growth Hormone and Fluid Homeostasis
Møller, J. (Aarhus)
185 Growth Hormone and Body Composition
Mersebach, H.; Feldt-Rasmussen, U. (Copenhagen)
196 Effects of Growth Hormone Deficiency and Growth Hormone Treatment
on Quality of Life in Growth Hormone-Deficient Adults
Arwert, L.I.; Deijen, J.B.; Drent, M.L. (Amsterdam)
209 Safety Aspects of Growth Hormone Replacement
Waterhouse, M.; Monson, J.P. (London)
222 Author Index
223 Subject Index
Contents VI
Foreword
Just over 20 years ago, I published a paper into the effects of radiotherapy
on pituitary tumors, and noted that the only major endocrinopathy that occurred
early was growth hormone deficiency: I dismissed this finding as ‘this was of
no clinical relevance since the patients were adult’ [Br Med J 1984;288:
110–1109]. How things have changed since then. Not only is the syndrome of
adult-onset growth hormone deficiency (AGHD) now well recognized and
described in detail, but thousands of adult patients throughout the world are
being treated with synthetic growth hormone on a regular basis. Much of the
early work on describing the syndrome originated in Europe, and the editors of
this volume have been at the forefront in this area from its inception. It now
seems appropriate at this point to draw breath, and assess exactly what is the
current status of AGHD, what are its defining clinical and biochemical features,
what are the risks and benefits of treatment, and what progress is likely in the
future. The editors of this volume have brought together a superb group of inter-
national experts in this area, and I am sure that this will become an essential
sourcebook for all practicing endocrinologists who take care of patients with
adult-onset growth hormone deficiency.
Ashley B. Grossman, London
VII

Preface
Growth hormone (GH) is essential for longitudinal growth and it has been
known for more than 40 years that GH-deficient children benefit from replace-
ment with the hormone. Based on experimental studies and Nature’s own exper-
iment with acromegaly it is, however, an even older observation that GH has
important biological actions in adults. In 1989, it was demonstrated that GH
deficiency in hypopituitary adults was associated with distinct abnormalities,
which could be reversed by GH replacement, and since 1994 this treatment
modality has been a licensed indication in most countries. Controversies do,
however, remain within this field and novel data continue to emerge.
This book provides an update on some of the pending issues. It encom-
passes the traditional end points of GH therapy such as body composition, bone
biology and physical performance. Attention is also devoted to diagnostic
aspects and side effects. Additional features range from clinical epidemiology
to quality of life, and novel areas such as the impact of traumatic brain injury
on pituitary function are also covered. The contributions stem from recognized
clinicians and scientists, who have been working in the field for decades.
Jens Otto Lunde Jørgensen, Aarhus
Jens Sandahl Christiansen, Aarhus
IX