Clinical and reimbursement issues in growth hormone use in adults

Data published in the past decade have demonstrated that adults who are def icient in growth hormone (GH) experience deleterious clinical consequences without treatment. In 1996, the Food and Drug Administration approved the u se of GK in adults who were GK deficient as a result of hypothalamic or pit uitary disease. However, there are other conditions in adults for which GH treatment has also been approved (acquired immune deficiency syndrome [AIDS ]-related wasting) or for which it is being considered, such as aging, cata bolic states, and cardiomyopathy. Clinical issues revolve around the ration ale for treatment; the diagnostic evaluation; the effects of GH therapy on body composition, bone density, lipids, and cardiac function; and appropria te dosing and follow up. Clearly the use of GPI in adults raises reimbursem ent issues as well. In this article, Dr. Beverly M.K. Biller provides an overview of the ration ale for the treatment of adult-onset GH deficiency and reviews its etiology and clinical features as well as reimbursement and utilization issues rela ted to treatment. Dr. Mary Lee Vance discusses various assays and criteria used in the diagnostic evaluation of the patient with adult-onset GH defici ency. Dr. David L. Kleinberg focuses on the effects of GH therapy,on body c omposition, bone density, lipid profiles, and cardiac function, as well as on reimbursement issues regarding body composition studies. To complete the clinical portion of this session, Dr. David M. Cook addresses dosing and f ollow up. To address economic implications, Dr. Terry Gordon provides the p ayer's perspective on the diagnosis and treatment of adult-onset GK deficie ncy.