Beyond the somatopause: growth hormone deficiency in adults over the age of 60 years

doi:10.1210/jc.81.2.460

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Beyond the somatopause: growth hormone deficiency in adults over the age of 60 years

AA Toogood, PA O'Neill and SM Shalet
Department of Endocrinology, Christie Hospital National Health Service Trust, Manchester, United Kingdom.

GH secretion declines by 14% decade of adult life, leading to the suggestion that people over the age of 60 yr are functionally GH deficient. If this is the case, one might not be able to detect a difference in GH secretion between the elderly with documented hypothalamic-pituitary disease and an age-matched control group. We studied GH secretion in 24 patients with hypothalamic-pituitary disease and 24 controls matched for body mass index and age using 24-h GH profiles, arginine stimulation tests, and serum insulin-like growth factor I (IGF-I) levels. The median (range) area under the curve of the GH profile [< 9.6 (< 9.6-20) vs. 18.5 (10.7-74.4) micrograms/L.24 h; P < 0.0001], the median stimulated peak GH response to arginine [< 0.4 (< 0.4-7.7) vs. 8.0 (1.6-37.0) micrograms/L; P < 0.0001], and the median serum IGF-I concentration [102 (< 14-162) vs. 147 (65-255) ng/mL; P = 0.0002] were significantly lower in the patients than in the controls. Fifteen patients showed no evidence of spontaneous or stimulated GH secretion, whereas all controls had evidence of both. The area under the GH curve in the 33 subjects with demonstrable GH secretion correlated significantly with the peak GH response to arginine (r = 0.71; P < 0.0001), but not with serum IGF-I concentration. This study suggests that organic GH deficiency in the elderly is distinct from the decline in GH secretion associated with the aging process. These patients may benefit from GH replacement therapy.

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				J. Svensson, J. D. Veldhuis, A. Iranmanesh, B.-A. Bengtsson, and G. Johannsson Increased Orderliness of Growth Hormone (GH) Secretion in GH-Deficient Adults with Low Serum Insulin-Like Growth Factor I J. Clin. Endocrinol. Metab., June 1, 2002; 87(6): 2863 - 2869. [Abstract] [Full Text] [PDF]

				B. M. K. Biller, M. H. Samuels, A. Zagar, D. M. Cook, B. M. Arafah, V. Bonert, S. Stavrou, D. L. Kleinberg, J. J. Chipman, and M. L. Hartman Sensitivity and Specificity of Six Tests for the Diagnosis of Adult GH Deficiency J. Clin. Endocrinol. Metab., May 1, 2002; 87(5): 2067 - 2079. [Abstract] [Full Text] [PDF]

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				A. A. Toogood and S. M. Shalet Growth Hormone Replacement Therapy in the Elderly with Hypothalamic-Pituitary Disease: A Dose-Finding Study J. Clin. Endocrinol. Metab., January 1, 1999; 84(1): 131 - 136. [Abstract] [Full Text]

				M. S. Gill, A. A. Toogood, P. A. O’Neill, M. O. Thorner, S. M. Shalet, and P. E. Clayton Urinary Growth Hormone (GH), Insulin-Like Growth Factor I (IGF-I), and IGF-Binding Protein-3 Measurements in the Diagnosis of Adult GH Deficiency J. Clin. Endocrinol. Metab., July 1, 1998; 83(7): 2562 - 2565. [Abstract] [Full Text]

				E. S. Kurland, F. K. W. Chan, C. J. Rosen, and J. P. Bilezikian Normal Growth Hormone Secretory Reserve in Men with Idiopathic Osteoporosis and Reduced Circulating Levels of Insulin-Like Growth Factor-I J. Clin. Endocrinol. Metab., July 1, 1998; 83(7): 2576 - 2579. [Abstract] [Full Text]

				S. R. Peacey, A. A. Toogood, and S. M. Shalet Hypothalamic Dysfunction in "Cured" Acromegaly Is Treatment Modality Dependent J. Clin. Endocrinol. Metab., May 1, 1998; 83(5): 1682 - 1686. [Abstract] [Full Text]

				S. M. Shalet, A. Toogood, A. Rahim, and B. M. D. Brennan The Diagnosis of Growth Hormone Deficiency in Children and Adults Endocr. Rev., April 1, 1998; 19(2): 203 - 223. [Abstract] [Full Text]

				S. W. Lamberts, A. W. van den Beld, and A. van der Lely The Endocrinology of Aging Science, October 17, 1997; 278(5337): 419 - 424. [Abstract] [Full Text]

ARTICLES

Beyond the somatopause: growth hormone deficiency in adults over the age of 60 years

				E. S. Kurland, C. J. Rosen, F. Cosman, D. McMahon, F. Chan, E. Shane, R. Lindsay, D. Dempster, and J. P. Bilezikian Insulin-Like Growth Factor-I in Men with Idiopathic Osteoporosis J. Clin. Endocrinol. Metab., September 1, 1997; 82(9): 2799 - 2805. [Abstract] [Full Text] [PDF]

				A. A. Toogood, R. M. Nass, S. S. Pezzoli, P. A. O'Neill, M. O. Thorner, and S. M. Shalet Preservation of Growth Hormone Pulsatility Despite Pituitary Pathology, Surgery, and Irradiation J. Clin. Endocrinol. Metab., July 1, 1997; 82(7): 2215 - 2221. [Abstract] [Full Text] [PDF]

				A. A. Toogood, J. E. Adams, P. A. O'Neill, and S. M. Shalet Elderly Patients with Adult-Onset Growth Hormone Deficiency Are Not Osteopenic J. Clin. Endocrinol. Metab., May 1, 1997; 82(5): 1462 - 1466. [Abstract] [Full Text] [PDF]

				C. A. Benbassat, K. C. Maki, and T. G. Unterman Circulating Levels of Insulin-Like Growth Factor (IGF) Binding Protein-1 and -3 in Aging Men: Relationships to Insulin, Glucose, IGF, and Dehydroepiandrosterone Sulfate Levels and Anthropometric Measures J. Clin. Endocrinol. Metab., May 1, 1997; 82(5): 1484 - 1491. [Abstract] [Full Text] [PDF]