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Clinical practice guideline for adult GH deficiency updated
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The Endocrine Society recently released new recommendations focusing on unique issues pertaining to the evaluation and treatment of adult growth hormone deficiency.
The recommendations, which were published in the Journal of Clinical Endocrinology & Metabolism, contain several major changes and address important concerns, such as stricter criteria for diagnosis, problems pertaining to transition from pediatric to adult care and areas requiring more research.
“This is an update of prior guidelines that were published in 2006,” Mark E. Molitch, MD, chair of the task force charged with writing the recommendations, told Endocrine Today. “[They] are really for treatment of adult GH deficiency and deal with both the child with GH deficiency who then becomes an adult as well as acquired GH deficiency during adulthood.”
Key updates
Although the task force revisited all recommendations from the 2006 clinical practice guideline, several areas underwent significant scrutiny, including diagnosis of idiopathic GH deficiency in adults. The phenomenon’s rarity coupled with a high false-positive error rate prompted the task force to suggest using two GH stimulation tests to diagnose the condition.
Molitch, who is professor medicine in the division of endocrinology, metabolism and molecular medicine at the Feinberg School of Medicine, Northwestern University, said the updates also address the issue of retesting patients with childhood GH deficiency. The task force recommends that retesting should occur 1 month after discontinuation of treatment. The guidelines also urge pediatric endocrinologists to discuss the potential need for continuing GH treatment into adulthood with patients and their parents early on.
“Pediatric endocrinologists need to lay the foundation right at the time of commencing GH treatment for what happens at the time of reaching a child’s peak height and explain that retesting may need to be done and that they may need to continue to take GH into adulthood,” Molitch said.
Important considerations
Molitch said there are areas that are controversial or may require future updates as more research emerges. The effects of BMI and age, for instance, on GH stimulation tests used for diagnosis require more attention, with several studies suggesting that different cut points may be needed for different populations. In addition, the benefits of GH on metabolism, energy and overall quality of life are well-documented, but no strong evidence confirms the treatment’s ability to reduce mortality in patients with hypopituitarism.
Even so, Molitch said the treatment has significant advantages. Only a small proportion of those with GH deficiency, however, are using the treatment.
“The final message is that GH treatment in adults may have substantial benefits for a large number of people, and it certainly should be considered in appropriate patients.” – by Melissa Foster
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Disclosure: Dr. Molitch reports receiving research support from Eli Lilly.
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