Growth Hormone Deficiency

Growth hormone (GH) deficiency is a disorder that involves the pituitary gland (a small gland located at the base of the brain), which produces growth hormone and other hormones. When the pituitary gland does not produce enough growth hormone, growth will be slower than normal.

Growth hormone is needed for normal growth in children. In adults, growth hormone is needed to maintain the proper amounts of body fat, muscle, and bone. In adults, low or absent growth hormone can also cause emotional symptoms, such as tiredness and lack of motivation. Cholesterol may also be affected. Adults with growth hormone deficiency usually have a history of pituitary tumors that may have been treated with surgery or radiation.

GH deficiency can occur at any age.

Growth hormone deficiency is caused by low or absent secretion of growth hormone from the pituitary gland. This can be caused by congenital (a condition that is present at birth) or acquired (a condition that occurs after birth) conditions. Congenital growth hormone deficiency may be associated with an abnormal pituitary gland, or it may be part of another syndrome. In normal aging, there is a decrease in the amount of growth hormone secreted each day and in the pattern of secretion. It is not clear if this is clinically important or requires any additional administration. Acquired causes of growth hormone deficiency include infections; brain tumors; and injury, surgery, or radiation to the head. In some cases, no causes can be identified.

Symptoms of GH deficiency in children include the following:

• Short stature
• 
  
• Low growth velocity (speed) for age and pubertal stage
• 
  
• Increased amount of fat around the waist
• 
  
• The child may look younger than other children his or her age
• 
  
• Delayed tooth development
• 
  
• Delayed onset of puberty

Symptoms of GH deficiency in adults include the following:

• Low energy
• 
  
• Decreased strength and exercise tolerance
• 
  
• Decreased muscle mass
• 
  
• Weight gain, especially around the waist
• 
  
• Feelings of anxiety, depression, or sadness causing a change in social behavior
• 
  
• Thin and dry skin

If there is a question of growth hormone deficiency in either a child or an adult, consultation with a pediatric or adult endocrinologist, as appropriate, is recommended.

To determine if growth hormone deficiency is present, a growth hormone stimulation test may be performed.

• This test involves injecting insulin (hormone that regulates blood sugar levels) through an IV to produce a low plasma glucose (a sugar) level. The peak growth hormone level is measured 20-30 minutes later.
• 
  
• If the peak growth hormone level is less than 10 mcg/mL in children or less than 3 mcg/mL in adults, growth hormone deficiency is diagnosed.

Persons with growth hormone deficiency may have increased total cholesterol, low-density lipoprotein (LDL) cholesterol, apolipoprotein B, and triglyceride levels.

Other tests that may be performed include a CT scan and/or MRI of the brain and/or bones. Images from these tests may reveal tumors. Reduced bone density can be evaluated by a DEXA or bone density scan.

|Self-Care at Home|

Because growth hormone deficiency can cause a lack of energy and strength, patients should eat a balanced diet, get regular exercise, and get plenty of sleep.

|Medications|

Children and some adults with growth hormone deficiency will benefit from growth hormone therapy. The goals of treatment are to increase growth in children and restore energy, metabolism, and body composition. The doctor may prescribe growth hormone, also called somatropin (Humatrope, Genotropin). The drug is given as shots a few times a week that is injected underneath the fat of the patient’s skin.

|Surgery|

Pituitary tumors may require surgery.

|Other Therapy|

Radiation therapy to the pituitary gland may be required if surgery for tumor removal cannot be safely accomplished.

|Follow-up|

Follow-up care with an endocrinologist (a doctor who specializes in studying hormones) is recommended.

|Outlook|

The prognosis is determined by the patient’s response to growth hormone replacement therapy and the underlying cause of the deficiency.

• Muscle mass may increase.
• 
  
• The patient may lose weight.
• 
  
• Exercise tolerance and performance may be increased.
• 
  
• Energy may increase.
• 
  
• Mood may improve.

Complications of growth hormone deficiency may include the following:

• Premature cardiovascular disease
• 
  
• Osteoporosis (a condition involving decreased bone mass and density)
• 
  
• Mental and emotional problems
• 
  
• Insulin resistance
• 
  
• Obesity and its complications
• 
  

|Support Groups and Counseling|

Some patients may benefit from counseling or joining a support group with other people who have growth hormone deficiency.

|Web Links|

Magic Foundation

Human Growth Foundation

The Hormone Foundation

Pituitary Network Association

Kids Health from the Nemours Foundation

GHD, hypopituitarism, pituitary gland, short stature, somatropin deficiency, somatotropin deficiency, growth hormone, GH

Author: Mohsen S Eledrisi, MD, FACP, FACE, Consultant and Assistant Professor, Department of Internal Medicine, Division of Endocrinology and Metabolism, King Abdulaziz National Guard Medical Center, Saudi Arabia.

Editors: Arthur B Chausmer, MD, PhD, FACP, FACE, FACN, CNS, Professor, Department of Internal Medicine, University of South Carolina School of Medicine; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, ; George T Griffing, MD, Director, Division of General Internal Medicine, Professor, Department of Internal Medicine, St Louis University.