Adult
growth hormone deficiency (AGHD) is a well-established clinical entity with heterogeneous characteristics, in which the main causes are hypothalamus-
pituitary tumors and/or their treatment. The diagnosis of
ADGH should be considered in patients with a prior history of childhood-onset GH deficiency or a history of organic hypothalamus-
pituitary disease. In these patients diagnosis is performed biochemically by provocative tests of GH secretion, once the measurement of the
biological markers for GH action:IGF-l and
IGFBP-3 levels, can be in the normal range in an important percentage of AGHD patients. The current treatment using an initial low dose of hrGH followed by individualised dose titration adjusted according to serum
IGF-1 levels, leads to similar beneficial effects with less incidence of side effects, improved tolerance to treatment and a lower stable GH dose as compared to hrGH replacement
therapy based on
body weight or body surface area. As some patients might not profit from hrGH
therapy, the potential beneficial effects of hrGH replacement
therapy should be analyzed on individualized basis. Alternative available
therapies with similar efficacy should be taken into consideration. Physical activity may improve body compostion, cardiovascular perfomance and well being in
ADGH subjects not submitted to hrGH treatment. An important target of hrGH replacement
therapy is its impact on quality of life, leading to social and professional improvement. Epidemiological evidence points to a decreasing life expectancy in
ADGH patients but data regarding the impact of hrGH replacement on life expectancy are still lacking.