Visit our website at: massgeneral.org/neuroendocrine NEUROENDOCRINE CLINICAL CENTER BULLETIN Reassessing Growth Hormone Deficiency in the

Since initial descriptions in the late 1950s ofgrowth hormone (GH) treatment for childrenwith short stature (1), the clinical use of GH has evolved substantially. Once extracted from cadaveric pituitary glands and administered in thrice weekly doses only to children with severe short stature (“pitu-itary dwarfism”), GH is now widely available via recombinant DNA technology and is used in both children and adults for a variety of indications (see Table). The expanding use of GH reflects a broadened understanding of its important metabolic effects beyond statural growth. Growth hormone is lipolytic and is anabolic to bone and muscle. As a result, indi-viduals with growth hormone deficiency (GHD) have relatively greater body fat mass, with preferential accumulation of visceral fat, as well as decreased lean mass and relatively reduced bone mass (2). GH replacement reverses these abnormalities in both children and adults. Moreover, GH plays a sig-nificant role in cardiovascular health. Individuals with GHD exhibit dyslipidemia, elevated systemic inflammatory markers, higher carotid intima-media thickness (cIMT), and abnormal endothelial function compared to the general population, and GH treat-ment ameliorates these abnormalities (3). Consequently, it is now well-accepted that GH treatment for GHD is appropriate not only in child-hood to maximize growth, but also throughout adult-hood to optimize body composition, bone health, and cardiovascular health. GHD diagnosed in childhood does not always persist into adulthood, however, so the completion of statural growth in childhood is a period at which GH is generally stopped, the diagno-sis of GHD reassessed, and GH replacement reinstat-ed at adult doses for those individuals who demon-strate persistent GHD on retesting