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Journal of Clinical Endocrinology & Metabolism, doi:10.1210/jc.2005-2227
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The Journal of Clinical Endocrinology & Metabolism Vol. 91, No. 5 1621-1634
Copyright © 2006 by The Endocrine Society

CLINICAL PRACTICE GUIDELINE

Evaluation and Treatment of Adult Growth Hormone Deficiency: An Endocrine Society Clinical Practice Guideline

Mark E. Molitch, David R. Clemmons, Saul Malozowski, George R. Merriam, Stephen M. Shalet, Mary Lee Vance for The Endocrine Society’s Clinical Guidelines Subcommittee

Northwestern University Feinberg School of Medicine (M.E.M.), Chicago, Illinois 60611; University of North Carolina School of Medicine (D.R.C.), Chapel Hill, North Carolina 27599; National Institute of Diabetes, Digestive and Kidney Disease (S.M.), National Institutes of Health, Bethesda, Maryland 20892; University of Washington, Veterans Affairs Puget Sound Health Care System (G.R.M.), Seattle and Tacoma, Washington 98493; Christie Hospital (S.M.S.), Manchester M20 4BX, United Kingdom; and University of Virginia Health Science Center (M.L.V.), Charlottesville, Virginia 22908

Address all correspondence to: The Endocrine Society, 8401 Connecticut Avenue, Suite 900, Chevy Chase, MD 20815. E-mail: govt-prof{at}endo-society.org. Telephone: 301-941-0200. Address all reprint requests for orders 101 and more to: Heather Edwards, Reprint Sales Specialist, Cadmus Professional Communications, Telephone: 410-691-6214, Fax: 410-684-2788 or by E-mail: endoreprints{at}cadmus.com. Address all reprint requests for orders 100 or less to Society Services at societyservices{at}endo-society.org.

Objective: The objective is to provide guidelines for the evaluation and treatment of adults with GH deficiency (GHD).

Participants: The chair of the Task Force was selected by the Clinical Guidelines Subcommittee of The Endocrine Society (TES). The chair selected five other endocrinologists and a medical writer, who were approved by the Council. One closed meeting of the group was held. There was no corporate funding, and members of the group received no remuneration.

Evidence: Only fully published, peer-reviewed literature was reviewed. The Grades of Evidence used are outlined in the Appendix.


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  		TABLE 2. Appendix

 
Consensus Process: Consensus was achieved through one group meeting and e-mailing of drafts that were written by the group with grammatical/style help from the medical writer. Drafts were reviewed successively by the Clinical Guidelines Subcommittee, the Clinical Affairs Committee, and TES Council, and a version was placed on the TES web site for comments. At each level, the writing group incorporated needed changes.

Conclusions: GHD can persist from childhood or be newly acquired. Confirmation through stimulation testing is usually required unless there is a proven genetic/structural lesion persistent from childhood. GH therapy offers benefits in body composition, exercise capacity, skeletal integrity, and quality of life measures and is most likely to benefit those patients who have more severe GHD. The risks of GH treatment are low. GH dosing regimens should be individualized. The final decision to treat adults with GHD requires thoughtful clinical judgment with a careful evaluation of the benefits and risks specific to the individual.




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