| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
Special Articles |
Address all correspondence and requests for reprints to: GRS Secretariat, Medical Department M, Aarhus Kommunehospital, DK- 8000, Aarhus C, Denmark.
 |
Abstract |
|---|
 Top Abstract IntroductionDiagnosis of GH Deficiency...Treatment of GH Deficiency... |
|---|
|
Introduction |
|---|
|
TopAbstractIntroductionDiagnosis of GH Deficiency...Treatment of GH Deficiency... |
|---|
Based on the increasing body of evidence that adults with GH deficiency (somatotropin deficiency) have impaired health that improves with GH replacement, many countries have already approved the use of GH for replacement therapy in adults with GH deficiency. To ensure that patients are appropriately identified and treated, the Growth Hormone Research Society (GRS) convened a workshop on April 14–17, 1997, in Port Stephens, Australia, to formulate consensus guidelines for the diagnosis and treatment of adults with GH deficiency. The GRS invited scientists with expertise in the field, representatives from industry involved in the manufacture of recombinant human GH, and representatives from health authorities from a number of countries to attend the workshop, all of whom contributed to the consensus guidelines as detailed below.
|
Diagnosis of GH Deficiency in Adults |
|---|
|
TopAbstractIntroductionDiagnosis of GH Deficiency...Treatment of GH Deficiency... |
|---|
Severe GH deficiency should be defined biochemically within an appropriate clinical context. In patients with hypothalamic-pituitary disease, the syndrome of adult GH deficiency characteristically presents with alterations in body composition, including reduced lean body mass and bone mineral density and increased fat mass with a preponderance of abdominal adiposity (increased waist circumference). The skin is thin and dry, and sweating is reduced. Muscle strength and exercise performance are reduced. An impaired sense of well-being and other psychological complaints are common. Partial GH deficiency exists, but further research is needed to distinguish it from physiological causes of reduced GH secretion, e.g. aging. Furthermore, the benefits of treatment of partial GH deficiency remain to be established.
Patients who should be tested for adult GH deficiency
An evaluation for GH deficiency should be considered only in patients with evidence of hypothalamic-pituitary disease, subjects who have received cranial irradiation, or patients with childhood onset of GH deficiency. In patients with organic hypothalamic-pituitary disease, the likelihood of GH deficiency increases with the increasing number of pituitary hormone deficits from approximately 45% if no other deficits are present to nearly 100% if three or four pituitary hormone deficiencies are present. It may not be necessary to evaluate patients with pituitary microadenomas for GH deficiency unless other pituitary hormone deficits are present or unless a strong clinical suspicion of GH deficiency exists. Patients with childhood-onset GH deficiency should be retested as adults before committing them to long term GH replacement.
Biochemical diagnosis of adult GH deficiency
Dynamic tests of GH secretion. The diagnosis of adult GH deficiency is established by provocative testing of GH secretion. Patients should be receiving stable and adequate hormone replacement for other hormonal deficits before testing. At present, the insulin tolerance test is the diagnostic test of choice. Provided adequate hypoglycemia is achieved, this test distinguishes GH deficiency from the reduced GH secretion that accompanies normal aging and obesity. The insulin tolerance test should be performed in experienced endocrine units where the test is performed frequently. The test is contraindicated in patients with electrocardiographic evidence or history of ischemic heart disease or in patients with seizure disorders. Given these precautions, the insulin tolerance test is safe; however, there is less experience in patients over the age of 60 yr.
Most normal subjects respond to insulin-induced hypoglycemia with a peak GH concentration of more than 5 µg/L. Severe GH deficiency is defined by a peak GH response to hypoglycemia of less than 3 µg/L. These cut-off values were defined in GH assays employing polyclonal competitive RIAs. However, GH immunoassay results vary between different methods, and therefore, the cut-off value may need to be adjusted appropriately (see below for standardization of assays).
In patients with contraindications to the insulin tolerance test, alternative provocative tests of GH secretion must be used with appropriate cut-offs. At present, the combined administration of arginine and GHRH is the most promising alternative. Administration of arginine alone or glucagon alone can be considered, but these tests have less established diagnostic value compared to the insulin tolerance test. Other stimulatory tests may prove to be useful, but require further validation. The present data indicate that the clonidine test is less useful in adults than in children.
Adult patients with hypothalamic-pituitary disease and one or more additional pituitary hormone deficits require only one provocative test of GH secretion for the diagnosis of GH deficiency. Childhood-onset GH deficiency requires reconfirmation in adulthood. To establish the diagnosis of isolated GH deficiency in adults, it is recommended that, in addition, a second biochemical test of GH status be abnormal.
Biochemical markers of GH action. Several biochemical markers of GH action have been studied to determine their diagnostic potential in adult GH deficiency. Serum insulin-like growth factor I (IGF-I) concentrations are only useful when age-adjusted normal ranges are available. In adults, a normal serum IGF-I does not exclude the diagnosis of GH deficiency. A serum IGF-I below the normal range is suggestive of GH deficiency in the absence of other conditions known to lower serum IGF-I levels; for example, malnutrition, hepatic disease, poorly controlled diabetes mellitus, and hypothyroidism. In the presence of multiple (two or more) pituitary hormone deficiencies, a low serum IGF-I level indicates a high probability of GH deficiency. However, it is recommended that the diagnosis of adult GH deficiency be confirmed by a provocative test of GH release.
Measurement of serum IGF-binding protein-3 or acidlabile subunit has to date not proven to offer any advantage over the measurement of serum IGF-I.
Standardization of assays
GH immunoassay results vary between different assay methods. The above recommendations for cut-off values for the insulin tolerance test are based on results obtained with polyclonal competitive RIAs calibrated against the pituitary-derived preparation International Reference Preparation (IRP) 80/505 (1 mg = 2.6 U). The GRS advocates future use of the recombinant hGH preparation IRP 88/624 (1 mg = 3.0 U). Further comparative studies are necessary at both national and international levels to achieve standardization of GH assays.
The presence of IGF-binding proteins interfere with measurement of serum IGF-I. At present, removal of IGF-binding proteins before immunoassay is essential. However, new IGF-I assays are being developed that may not require extraction procedures. The current international reference standard for IGF-I assays is IRP 87/518. GH and IGF-I results should be expressed in mass units.
|
Treatment of GH Deficiency in Adults |
|---|
|
TopAbstractIntroductionDiagnosis of GH Deficiency...Treatment of GH Deficiency... |
|---|
All patients with documented severe GH deficiency are eligible for GH replacement. The goal for GH replacement in adults is to correct the abnormalities associated with adult GH deficiency.
Dose selection
The objective of treatment is to maximize benefit and minimize side-effects. Experience has shown that sensitivity to GH treatment varies considerably between individuals, with elderly individuals being the most sensitive. It is recommended that therapy should start with a low dose (0.15–0.30 mg/day; 0.45–0.90 IU/day). The dosage should be increased gradually on the basis of clinical and biochemical responses and no more frequently than at monthly intervals. The maintenance dose may vary considerably from person to person and seldom exceeds 1.0 mg/day (3 IU/day).
In healthy adults it is known that premenopausal women secrete more GH than age-matched men, and that GH secretion is reduced with advancing age and with obesity. In adults aged 30–50 yr, the reported daily production of GH in women was approximately 0.2 mg/day, whereas the production rate in men was approximately 0.1 mg/day. Clinical experience has demonstrated that the variability in sc absorption and individual responsiveness to GH make dose determination based on body weight or body surface area less helpful than anticipated. Furthermore, some adult patients experience side-effects even with a low dose.
In accordance with the clinical practice of treating GH-deficient children, we recommend that GH be administered as daily sc self-injections in the evening.
Monitoring treatment efficacy
A physical examination and a careful clinical history with particular attention to quality of life-related questions are of great value in monitoring treatment. Where appropriate, questioning the patient’s partner may also assist with the evaluation.
At present, the best biochemical marker of GH action is IGF-I in serum. An important use of IGF-I measurements is to avoid overreplacement, and values should be kept in the age-related normal range. IGFBP-3 has been found to be less useful, whereas acid-labile subunit, although promising, needs further validation. In the initial stages of dose titration, frequent measurements are required (every 1 or 2 months). Once a stable dose has been reached, once or twice yearly measurements are sufficient.
Simple anthropometric measures, such as weight and waist circumference, may be supplemented by bioelectrical impedance or dual x-ray absorptiometry; the latter is particularly valuable when bone mineral density is reduced. Lipids should be monitored annually.
Safety issues
Adult GH deficiency is associated with reduced extracellular fluid volume. Fluid retention during GH treatment is, therefore, to be expected, and the patient should be informed. Edema and occasionally carpal tunnel syndrome may be seen. These symptoms are usually transient and dose dependent, but may require a dose reduction. Mild arthralgias may occur, but are usually self-limiting. Because GH may reduce insulin sensitivity, markers of glycemia should be monitored periodically.
The risk of certain malignancies, in particular colon cancer, is increased in acromegaly. It is, however, inappropriate to extrapolate from the acromegalic data to the GH-replaced adult with hypopituitarism. Nonetheless, current recommendations for cancer prevention and early detection in the general population should be implemented.
Good clinical practice requires regular imaging of residual pituitary tumor; GH replacement does not impose a need for intensifying this follow-up. A baseline scan is recommended before starting treatment.
GH influences the metabolism of many substances, including other hormones and medications; therefore, alterations in the dose requirements of such compounds should be anticipated.
Contraindications
Absolute contraindications include active malignancy, benign intracranial hypertension, and proliferative or preproliferative diabetic retinopathy. Early pregnancy is not a contraindication, although GH should be discontinued in the second trimester as GH is produced by the placenta.
Long-term care
Although insufficient information is available at present, GH replacement (as with other hormones) is most likely for life. It is possible that the dose requirement may decrease over time. Replacement therapy in the elderly should be monitored particularly carefully as the patient ages, with special emphasis on dosage and perceived benefit. If any patient perceives no benefit, then a trial of withdrawal should be considered.
It is recommended that patients with hypopituitarism receiving GH replacement should remain under long term surveillance by an endocrinologist with special experience in pituitary disease; this can be undertaken in partnership with an internist or general practitioner.
Patients may need initially to be seen initially by the endocrinologist as often as monthly. Once treatment is stabilized, one or two visits per year will suffice.
|
Footnotes |
|---|
Received July 25, 1997.
Accepted October 10, 1997.
This article has been cited by other articles:
 |
|
 |
|
  H. Jorn Schneider, J. Klotsche, B. Saller, S. Bohler, C. Sievers, D. Pittrow, G. Ruf, W. Marz, W. Erwa, A. M Zeiher, et al. Associations of age-dependent IGF-I SDS with cardiovascular diseases and risk conditions: cross-sectional study in 6773 primary care patients Eur. J. Endocrinol., February 1, 2008; 158(2): 153 - 161. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. K Y Ho and on behalf of the 2007 GH Deficiency Consensus Work Consensus guidelines for the diagnosis and treatment of adults with GH deficiency II: a statement of the GH Research Society in association with the European Society for Pediatric Endocrinology, Lawson Wilkins Society, European Society of Endocrinology, Japan Endocrine Society, and Endocrine Society of Australia Eur. J. Endocrinol., December 1, 2007; 157(6): 695 - 700. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Corneli, C. Di Somma, F. Prodam, J. Bellone, S. Bellone, V. Gasco, R. Baldelli, S. Rovere, H. J. Schneider, L. Gargantini, et al. Cut-off limits of the GH response to GHRH plus arginine test and IGF-I levels for the diagnosis of GH deficiency in late adolescents and young adults Eur. J. Endocrinol., December 1, 2007; 157(6): 701 - 708. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Chihara, A. Shimatsu, N. Hizuka, T. Tanaka, Y. Seino, Y. Katofor, and the KP-102 Study Group A simple diagnostic test using GH-releasing peptide-2 in adult GH deficiency Eur. J. Endocrinol., July 1, 2007; 157(1): 19 - 27. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Brabant GH releasing peptide 2 test: the holy grail of testing GH deficiency? Eur. J. Endocrinol., July 1, 2007; 157(1): 29 - 30. [Full Text] [PDF]
|
|
|
|
|
|
H. Urushihara, S. Fukuhara, S. Tai, S. Morita, and K. Chihara Heterogeneity in responsiveness of perceived quality of life to body composition changes between adult- and childhood-onset Japanese hypopituitary adults with GH deficiency during GH replacement Eur. J. Endocrinol., June 1, 2007; 156(6): 637 - 645. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Keller, Z. Wu, J. Kratzsch, E. Keller, W. F Blum, A. Kniess, R. Preiss, J. Teichert, C. J Strasburger, and M. Bidlingmaier Pharmacokinetics and pharmacodynamics of GH: dependence on route and dosage of administration Eur. J. Endocrinol., June 1, 2007; 156(6): 647 - 653. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. D. Murray, M. Bidlingmaier, C. J. Strasburger, and S. M. Shalet The Diagnosis of Partial Growth Hormone Deficiency in Adults with a Putative Insult to the Hypothalamo-Pituitary Axis J. Clin. Endocrinol. Metab., May 1, 2007; 92(5): 1705 - 1709. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. A van der Klaauw, N. R Biermasz, E. J M Feskens, M. B Bos, J. W A Smit, F. Roelfsema, E. P M Corssmit, H. Pijl, J. A Romijn, and A. M Pereira The prevalence of the metabolic syndrome is increased in patients with GH deficiency, irrespective of long-term substitution with recombinant human GH Eur. J. Endocrinol., April 1, 2007; 156(4): 455 - 462. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Marzullo, C. Marcassa, R. Campini, E. Eleuteri, A. Minocci, A. Sartorio, R. Vettor, A. Liuzzi, and G. Grugni Conditional Cardiovascular Response to Growth Hormone Therapy in Adult Patients with Prader-Willi Syndrome J. Clin. Endocrinol. Metab., April 1, 2007; 92(4): 1364 - 1371. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D Deepak, N J Furlong, J P H Wilding, and I A MacFarlane Cardiovascular disease, hypertension, dyslipidaemia and obesity in patients with hypothalamic-pituitary disease Postgrad. Med. J., April 1, 2007; 83(978): 277 - 280. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. M Morrison, M. Bidlingmaier, S. Stadler, Z. Wu, L. Skriver, and C. J Strasburger Sample pre-treatment determines the clinical usefulness of acid-labile subunit immunoassays in the diagnosis of growth hormone deficiency and acromegaly Eur. J. Endocrinol., March 1, 2007; 156(3): 331 - 339. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Raschke, M. H. Rasmussen, S. Govender, D. Segal, M. Suntum, and J. S. Christiansen Effects of growth hormone in patients with tibial fracture: a randomised, double-blind, placebo-controlled clinical trial Eur. J. Endocrinol., March 1, 2007; 156(3): 341 - 351. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Pecori Giraldi, M. Andrioli, L. De Marinis, A. Bianchi, A. Giampietro, M. De Martin, E. Sacco, M. Scacchi, A. Pontecorvi, and F. Cavagnini Significant GH deficiency after long-term cure by surgery in adult patients with Cushing's disease Eur. J. Endocrinol., February 1, 2007; 156(2): 233 - 239. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. M. Wieselthaler, M. Riedl, H. Schima, O. Wagner, W. Waldhausl, E. Wolner, A. Luger, and M. Clodi Endocrine function is not impaired in patients with a continuous MicroMed-DeBakey axial flow pump J. Thorac. Cardiovasc. Surg., January 1, 2007; 133(1): 2 - 6. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. T. Pellecchia, R. Pivonello, A. Colao, and P. Barone Growth Hormone Stimulation Tests in the Differential Diagnosis of Parkinson's Disease Clin. Med. Res., December 1, 2006; 4(4): 322 - 325. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H J Schneider, B L Herrmann, M Schneider, C Sievers, L Schaaf, and G K Stalla Discrepant results in the diagnosis of GH deficiency with the insulin-tolerance test and the GHRH plus arginine test in patients with traumatic brain injury. Eur. J. Endocrinol., October 1, 2006; 155(4): 553 - 557. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Bidlingmaier, J. Kim, C. Savoy, M. J. Kim, N. Ebrecht, S. de la Motte, and C. J. Strasburger Comparative Pharmacokinetics and Pharmacodynamics of a New Sustained-Release Growth Hormone (GH), LB03002, Versus Daily GH in Adults with GH Deficiency J. Clin. Endocrinol. Metab., August 1, 2006; 91(8): 2926 - 2930. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. J Trainer, J. Barth, C. Sturgeon, G. Wieringaon, and on behalf of the collaborative Consensus statement on the standardisation of GH assays. Eur. J. Endocrinol., July 1, 2006; 155(1): 1 - 2. [Full Text] [PDF]
|
|
|
|
|
|
A A van der Klaauw, A M Pereira, S W van Thiel, J W A Smit, E P M Corssmit, N R Biermasz, M Frolich, A Iranmanesh, J D Veldhuis, F Roelfsema, et al. GH deficiency in patients irradiated for acromegaly: significance of GH stimulatory tests in relation to the 24 h GH secretion. Eur. J. Endocrinol., June 1, 2006; 154(6): 851 - 858. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Colao, C. Di Somma, S. Spiezia, F. Rota, R. Pivonello, S. Savastano, and G. Lombardi The Natural History of Partial Growth Hormone Deficiency in Adults: A Prospective Study on the Cardiovascular Risk and Atherosclerosis J. Clin. Endocrinol. Metab., June 1, 2006; 91(6): 2191 - 2200. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S Pekic, M Doknic, D Miljic, M Joksimovic, J Glodic, M Djurovic, C Dieguez, F Casanueva, and V Popovic Ghrelin test for the assessment of GH status in successfully treated patients with acromegaly. Eur. J. Endocrinol., May 1, 2006; 154(5): 659 - 666. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. J. Schneider, B. Saller, J. Klotsche, W. Marz, W. Erwa, H.-U. Wittchen, and G. K. Stalla Opposite associations of age-dependent insulin-like growth factor-I standard deviation scores with nutritional state in normal weight and obese subjects. Eur. J. Endocrinol., May 1, 2006; 154(5): 699 - 706. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. E. Molitch, D. R. Clemmons, S. Malozowski, G. R. Merriam, S. M. Shalet, M. L. Vance, and for The Endocrine Society's Clinical Guidelines Su Evaluation and Treatment of Adult Growth Hormone Deficiency: An Endocrine Society Clinical Practice Guideline J. Clin. Endocrinol. Metab., May 1, 2006; 91(5): 1621 - 1634. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V K B Prabhakar and S M Shalet Aetiology, diagnosis, and management of hypopituitarism in adult life. Postgrad. Med. J., April 1, 2006; 82(966): 259 - 266. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H J Schneider, M Schneider, B Saller, S Petersenn, M Uhr, B Husemann, F von Rosen, and G K Stalla Prevalence of anterior pituitary insufficiency 3 and 12 months after traumatic brain injury Eur. J. Endocrinol., February 1, 2006; 154(2): 259 - 265. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. D. Murray, J. E. Adams, and S. M. Shalet A Densitometric and Morphometric Analysis of the Skeleton in Adults with Varying Degrees of Growth Hormone Deficiency J. Clin. Endocrinol. Metab., February 1, 2006; 91(2): 432 - 438. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. R Greenfield and K. Samaras Evaluation of pituitary function in the fatigued patient: a review of 59 cases Eur. J. Endocrinol., January 1, 2006; 154(1): 147 - 157. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J Ayuk and M C Sheppard Growth hormone and its disorders Postgrad. Med. J., January 1, 2006; 82(963): 24 - 30. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Agha, M. Sherlock, S. Brennan, S. A. O'Connor, E. O'Sullivan, B. Rogers, C. Faul, D. Rawluk, W. Tormey, and C. J. Thompson Hypothalamic-Pituitary Dysfunction after Irradiation of Nonpituitary Brain Tumors in Adults J. Clin. Endocrinol. Metab., December 1, 2005; 90(12): 6355 - 6360. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Faggiano, D. Melis, R. Alfieri, M. De Martino, M. Filippella, F. Milone, G. Lombardi, A. Colao, and R. Pivonello Sulfur Amino Acids in Cushing's Disease: Insight in Homocysteine and Taurine Levels in Patients with Active and Cured Disease J. Clin. Endocrinol. Metab., December 1, 2005; 90(12): 6616 - 6622. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. S. Miller and D. Yee Type I Insulin-like Growth Factor Receptor as a Therapeutic Target in Cancer Cancer Res., November 15, 2005; 65(22): 10123 - 10127. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Bjork, K. Link, and E. M. Erfurth The Utility of the Growth Hormone (GH) Releasing Hormone-Arginine Test for Diagnosing GH Deficiency in Adults with Childhood Acute Lymphoblastic Leukemia Treated with Cranial Irradiation J. Clin. Endocrinol. Metab., November 1, 2005; 90(11): 6048 - 6054. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K Borm, M Slawik, F Beuschlein, L Seiler, F Flohr, A Berg, A Koenig, and M Reincke Low-dose glucose infusion after achieving critical hypoglycemia during insulin tolerance testing: effects on time of hypoglycemia, neuroendocrine stress response and patient's discomfort in a pilot study Eur. J. Endocrinol., October 1, 2005; 153(4): 521 - 526. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A Munafo, T X Q Nguyen, O Papasouliotis, H Lecuelle, A Priestley, and M O Thorner Polyethylene glycol-conjugated growth hormone-releasing hormone is long acting and stimulates GH in healthy young and elderly subjects Eur. J. Endocrinol., August 1, 2005; 153(2): 249 - 256. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Corneli, C. Di Somma, R. Baldelli, S. Rovere, V. Gasco, C. G. Croce, S. Grottoli, M. Maccario, A. Colao, G. Lombardi, et al. The cut-off limits of the GH response to GH-releasing hormone-arginine test related to body mass index Eur. J. Endocrinol., August 1, 2005; 153(2): 257 - 264. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Chihara, E. Koledova, A. Shimatsu, Y. Kato, H. Kohno, T. Tanaka, A. Teramoto, P. C Bates, and A. F Attanasio An individualized GH dose regimen for long-term GH treatment in Japanese patients with adult GH deficiency Eur. J. Endocrinol., July 1, 2005; 153(1): 57 - 65. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Bondanelli, M. R. Ambrosio, M. C. Zatelli, L. De Marinis, and E. C d. Uberti Hypopituitarism after traumatic brain injury Eur. J. Endocrinol., May 1, 2005; 152(5): 679 - 691. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. Kreitschmann-Andermahr, J. M. Gilsbach, I. Dimopoulou, and S. Tsagarakis Diagnosing Growth Hormone Deficiency After Aneurysmal Subarachnoid Hemorrhage * Response: Stroke, May 1, 2005; 36(5): 931 - 932. [Full Text] [PDF]
|
|
|
|
|
|
S. V Haijma, P S. van Dam, W. R de Vries, I. Maitimu-Smeele, C. Dieguez, F. F Casanueva, and H. P F Koppeschaar The GHRH/GHRP-6 test for the diagnosis of GH deficiency in elderly or severely obese men Eur. J. Endocrinol., April 1, 2005; 152(4): 575 - 580. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Kelestimur, P. Jonsson, S. Molvalilar, J. M. Gomez, C. J Auernhammer, R. Colak, M. Koltowska-Haggstrom, and M. I Goth Sheehan's syndrome: baseline characteristics and effect of 2 years of growth hormone replacement therapy in 91 patients in KIMS - Pfizer International Metabolic Database Eur. J. Endocrinol., April 1, 2005; 152(4): 581 - 587. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Maghnie, G. Aimaretti, S. Bellone, G. Bona, J. Bellone, R. Baldelli, C. de Sanctis, L. Gargantini, R. Gastaldi, L. Ghizzoni, et al. Diagnosis of GH deficiency in the transition period: accuracy of insulin tolerance test and insulin-like growth factor-I measurement Eur. J. Endocrinol., April 1, 2005; 152(4): 589 - 596. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
X.-D. Qu, I. T. Gaw Gonzalo, M. Y. Al Sayed, P. Cohan, P. D. Christenson, R. S. Swerdloff, D. F. Kelly, and C. Wang Influence of Body Mass Index and Gender on Growth Hormone (GH) Responses to GH-Releasing Hormone Plus Arginine and Insulin Tolerance Tests J. Clin. Endocrinol. Metab., March 1, 2005; 90(3): 1563 - 1569. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P E Clayton, R C Cuneo, A Juul, J P Monson, S M Shalet, and M Tauber Consensus statement on the management of the GH-treated adolescent in the transition to adult care Eur. J. Endocrinol., February 1, 2005; 152(2): 165 - 170. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. L Boguszewski, L. H F Meister, D. C T Zaninelli, and R. B Radominski One year of GH replacement therapy with a fixed low-dose regimen improves body composition, bone mineral density and lipid profile of GH-deficient adults Eur. J. Endocrinol., January 1, 2005; 152(1): 67 - 75. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Koutkia, B. Canavan, J. Breu, and S. Grinspoon Growth Hormone (GH) Responses to GH-Releasing Hormone-Arginine Testing in Human Immunodeficiency Virus Lipodystrophy J. Clin. Endocrinol. Metab., January 1, 2005; 90(1): 32 - 38. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Colao, C. Di Somma, A. Cuocolo, M. Filippella, F. Rota, W. Acampa, S. Savastano, M. Salvatore, and G. Lombardi The Severity of Growth Hormone Deficiency Correlates with the Severity of Cardiac Impairment in 100 Adult Patients with Hypopituitarism: An Observational, Case-Control Study J. Clin. Endocrinol. Metab., December 1, 2004; 89(12): 5998 - 6004. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Agha, B. Rogers, M. Sherlock, P. O'Kelly, W. Tormey, J. Phillips, and C. J. Thompson Anterior Pituitary Dysfunction in Survivors of Traumatic Brain Injury J. Clin. Endocrinol. Metab., October 1, 2004; 89(10): 4929 - 4936. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Link, C. Moell, S. Garwicz, E. Cavallin-Stahl, J. Bjork, U. Thilen, B. Ahren, and E. M. Erfurth Growth Hormone Deficiency Predicts Cardiovascular Risk in Young Adults Treated for Acute Lymphoblastic Leukemia in Childhood< |
