Body composition as a clinical endpoint in the treatment of growth hormonedeficiency

Endpoints in the treatment and management of adults with growth hormone (GH ) deficiency(GHD) can be problematic. Changes in body composition with reco mbinant human GH (rhGH) treatment may be one of the most objective measures that could be applied in judging the effectiveness and long-term efficacy. The relative strengths and weaknesses of measures of body com position and their potential for clinical utility in the setting of rhGH replacement in GHD in adults are discussed. Measurement of changes in body fat, regardles s of the method employed, from pretreatment baseline through 2-6 months of treatment may be quite useful in demonstrating the efficacy of rhGH in each patient. Other changes in body composition are compromised by the imprecis ion of the measurements, shifts in extracellular water, and the small real changes which occur in bone and muscle in the GHD subject. Use of body comp osition measures of change in fat content as an endpoint in determining the efficacy of rhGH treatment in adults with GHD cannot be implemented on the basis of current data and would require a carefully designed prospective, controlled study. Until such criteria are established and accepted, endocri nologists must continue to manage these patients purely on the basis of the ir clinical judgment. Copyright (C) 1999 S. Karger AG, Basel.