GROWTH-HORMONE DEFICIENCY IN ADULTS - THE ROLE OF REPLACEMENT THERAPY

Although growth hormone has been in clinical use for almost 40 years t o promote linear growth in children with growth hormone deficiency, re placement therapy in adults was previously not deemed clinically indic ated. However, intensive research over the past decade has led to impo rtant advances in our medical knowledge and improvements in the care f or patients with growth hormone deficiency. Well-controlled clinical t rials have demonstrated beneficial effects of replacement therapy with recombinant human prion-free growth hormone (rhGH; somatropin). The m ost important restoration parameters include reduction of cardiovascul ar risk factors and improved lipid profile, normalised body compositio n, improved exercise capacity and bone mass, as well as enhanced psych ological well-being. Some important issues regarding growth hormone de ficiency and long term somatropin treatment are unresolved, such as di agnostic criteria and the potential for malignancy and impaired glucos e tolerance. Furthermore, the effect on hard end-points such as life e xpectancy or vertebral fracture rate is unknown, but is expected to em erge from physician-managed, multinational databases. Consequently, at this point somatropin therapy should be given in conjunction with cli nical trials.