Adult Human Growth Hormone HGH Deficiency

Mounting evidence reveals GHD (somatotropin deficiency) impacts a patient’s quality of life, impairs health (such as microvascular alterations), body composition and regional tissue distribution. All are responsive to growth hormone replacement. The key is in properly identifying GHD patients. Review current research and medical articles on reliable tools for GHD identification, the efficacy and safety of GH therapy, short and long-term effects of recombinant hGH, treatment with sleep disorders, among other relevant issues.

Risk Factors of Cardiovascular Disease in GH-Deficient Adults with Hypopituitarism: A Preliminary Report.pdf

This study concluded that an atherogenic lipid profile, insulin resistance, obesity, and increased body and trunk fat in GHD adults may cause the higher risk of cardiovascular disease in these patients. GHD adults should receive human recombinant GH along with conventional replacement therapy. This may be a useful method in protecting against early onset of atherosclerosis, metabolic disturbances, and osteoporosis, especially in young patients.
Bohdanowicz-Pawlak, A., Szymczak, J., Bladowska, J., Bednarek-Tupikowska, G., Bidzinska, B. & Milewicz, A. (2006). Risk factors of cardiovascular disease in GH-deficient adults with hypopituitarism: a preliminary report [Electronic version]. Medical Science Monitor, 12(2), CR75-80. Epub January 26, 2006. Retrieved November 14, 2006.

A Drug’s Promise (or not) of Youth.pdf

The author of this article says that growth hormone is the anti-aging industry’s most potent and controversial weapon. Some say it works wonders. Some say it could shorten your life.
Alexander, B. (2006, July 9). A drug’s promise (or not) of youth [Electronic version]. LATimes.com. Retrieved November 15, 2006.

Does Growth Hormone Cause Cancer?.pdf

This study concluded that even if GH/IGF-1 therapy does result in a small increase in cancer risk compared to untreated patients with GH deficiency, it is likely that the eventual risk will be the same as the general population. Such a restoration to normality will need to be balanced against the known morbidity of untreated GH deficiency.
Jenkins, P.J., Mukherjee, A. & Shalet, S.M. (2006). Does growth hormone cause cancer? [Electronic version]. Clinical Endocrinology (Oxford), 64(2), 115-121. Retrieved November 14, 2006.

Hormones May Hold Clues to Healthy Aging.pdf

Two new studies suggest that specific hormones may play a key role in longevity and healthy aging.  Researchers found one hormone, adiponectin, at higher-than-average concentrations in 100-year-old women, while another study found that stimulating the body's production of growth hormone brought a youthful pep back to people in their 60s to 80s.
Reinberg, S. (2006, June 21). Hormones may hold clues to healthy aging [Electronic version]. HealthDay News. Retrieved July 18, 2006.

Toward the Development of a Test for Growth Hormone (GH) Abuse: A Study of Extreme Physiological Ranges of GH-Dependent Markers in 813 Elite Athletes in the Postcompetition Setting.pdf

This study was undertaken to determine the physiological range of these GH-dependent variables in elite athletes after a competitive event to determine whether such values differ from resting values in normal and athletic subjects and to establish whether any adjustments to this range are required on the basis of age, gender, demographic characteristics, or the nature of the exercise performed.
Healy, M.L., Dall, R., Gibney, J., Bassett, E., Ehrnborg, C., Pentecost, C., et al. (2005). Toward the development of a test for growth hormone (GH) abuse: a study of extreme physiological ranges of GH-dependent markers in 813 elite athletes in the postcompetition setting [Electronic version]. The Journal of Clinical Endocrinology and Metabolism, 90(2), 641-649. Epub 2004, November 16. Retrieved November 18, 2005.

17Beta-Estradiol Regulation of Human Growth Hormone (hGH), Insulin-Like Growth Factor-I (IGF-I) and Insulin-Like Growth Factor Binding Protein-3 (IGFBP-3) Axis in Hypoestrogenic, Hypergonadotropic Women.pdf

According to this study, 17b-estradiol may be as important contributor to insulin-like growth factor-I (IGF-I) plasma level as age in hypoestrogenic, hypogonadotropic women.
Milewicz, T., Krzysiek, J., Sztefko, K, Radowicki, S. & Krzyczkowska-Sendrakowska, M. (2005). 17beta-estradiol regulation of human growth hormone (hGH), insulin-like growth factor-I (IGF-I) and insulin-like growth factor binding protein-3 (IGFBP-3) axis in hypoestrogenic, hypergonadotropic women [Electronic version]. Endokrynologia Polska, 56(6), 876-882. Retrieved November 27, 2006.

Levels of Serum C-Reactive Protein During Oral and Transdermal Estradiol in Postmenopausal Women with and without a History of Intrahepatic Cholestasis of Pregnancy.pdf

This study concluded that the synthesis of CRP is not affected by a history of ICP. It is readily and dose dependently stimulated by oral but not by transdermal E2 in as soon as 2 wk.
Ropponen, A., Aittomaki, K., Tikkanen, M.J. & Ylikorkala, O. (2005). Levels of serum c-reactive protein during oral and transdermal estradiol in postmenopausal women with and without a history of intrahepatic cholestasis of pregnancy [Electronic version]. The Journal of Clinical Endocrinology and Metabolism, 90(1), 142-146. Retrieved November 18, 2005.

The Severity of Growth Hormone Deficiency Correlates with the Severity of Cardiac Impairment in 100 Adult Patients with Hypopituitarism: An Observational, Case-Control Study.pdf

The conclusion of this study was that cardiac performance is correlated with the GH status because significant impairment was found in patients with severe and partial GHD but not in non-GHD hypopituitary patients.
Colao, A., Di Somma, C., Cuocolo, A., Filippella, M., Rota, F., Acampa, W., et al. (2004). The severity of growth hormone deficiency correlates with the severity of cardiac impairment in 100 adult patients with hypopituitarism: an observational, case-control study [Electronic version]. The Journal of Clinical Endocrinology and Metabolism, 89(12), 5998-6004. Retrieved November 18, 2005.

Insulin-Like Growth Factor-1 as a Vascular Protective Factor.pdf

According to this study, until recently, IGF-1 was considered a mediator of vascular disease. Increasing evidence indicates, instead, that IGF-1 protects against endothelial dysfunction, atherosclerotic plaque development, the metabolic syndrome, clinical instability, and ischemic myocardial damage.
Conti, E., Carrozza, C., Capoluongo, E., Volpe, M., Crea, F., Zuppi, C., et al. (2004). Insulin-like growth factor-1 as a vascular protective factor [Electronic version]. Circulation, 110(15), 2260-2265. Retrieved May 18, 2005.

The Serum Growth Hormone to Somatostatin Ratio is Skewed Upward in Rheumatoid Arthritis Patients.pdf

These results of this study indicated that symptomatic RA is associated with elevated serum growth hormone without concomitant changes in IGF-1 compared to individuals from the control group. Reduced somatostatin levels in older RA patients resulted in a skewed upward growth hormone to somatostatin ratio. It was concluded that the serum growth hormone to somatostatin ratio may be a useful surrogate marker of disease activity in symptomatic RA.
Denko, C.W. & Malemud, C.J. (2004). The serum growth hormone to somatostatin ratio is skewed upward in rheumatoid arthritis patients [Electronic version]. Frontiers in Bioscience, 9, 1660-1664. Retrieved October 25, 2005.

Efficacy and Tolerability of an Individualized Dosing Regimen for Adult Growth Hormone Replacement Therapy in Comparison with Fixed Body Weight-Based Dosing.pdf

This study concluded that GH replacement therapy should be initiated at a low dose and titrated to a dose producing maximal benefits without adverse side effects and an IGF-I level within the age- and sex-adjusted normal range.
Hoffman, A.R., Strasburger, C.J., Zagar, A., Blum, W.F., Kehely, A., Hartman, M.L., et al. (2004). Efficacy and tolerability of an individualized dosing regimen for adult growth hormone replacement therapy in comparison with fixed body weight-based dosing [Electronic version]. The Journal of Clinical Endocrinology and Metabolism, 89(7), 3224-3233. Retrieved November 21, 2005.

Potential Anabolic Effects of Androgens on Bone.pdf

With the decrease of estrogen at menopause, the need for androgens increases in post-menopausal women.  Androgens also appear to be important for the bone health of women who are pre-menopausal.
Kearns, A.E. & Khosla, S. (2004). Potential anabolic effects of androgens on bone [Electronic version]. Mayo Clinic Proceedings, 79(4 Suppl.), S14-18. Retrieved May 18, 2005.

Growth Hormone-Releasing Hormone in HIV-Infected Men with Lipodystrophy: A Randomized Controlled Trial.pdf

This study concluded that GHRH was well tolerated and effectively increased levels of IGF-1 in HIV-infected men with lipodystrophy. Total and regional body composition improved in response to GHRH, with increased lean mass and reduced truncal and visceral fat. Use of GHRH may potentially be a beneficial treatment strategy for this population.
Koutkia, P., Canavan, B., Breu, J., Torriani, M., Kissko, J. & Grinspoon, S. (2004). Growth hormone-releasing hormone in HIV-infected men with lipodystrophy: a randomized controlled trial [Electronic version]. The Journal of the American Medical Association, 292(2), 210-218. Retrieved October 11, 2005.

The Paradox of the Insulin/IGF-1 Signaling Pathway in Longevity.pdf

This review focuses on the downstream cascade of events in the insulin and IGF-1 signaling to identify specific pathways that are relevant to human longevity.
Rincon, M., Muzumdar, R., Atzmon, G. & Barzilai, N. (2004). The paradox of the insulin/IGF-1 signaling pathway in longevity [Electronic version].  Mechanisms of Ageing & Development, 125(6), 397-403. Retrieved September 19, 2005.

Long-Term Improvement of Quality of Life During Growth Hormone (GH)

This study demonstrates that 1) improvements in QoL, as measured by the QLS-H, are maintained during long-term GH replacement therapy of adults with GHD, and 2) the QLS-H is a useful tool for evaluating QoL in hypopituitary patients treated in clinical practice. The authors suggest that evaluation of QoL should be a part of the routine clinical management of adult GH-deficient patients, complementing the measurement of surrogate biological markers or other clinical end points.
Rosilio, M., Blum, W.F., Edwards, D.J., Shavrikova, E.P., Valle, D., Lamberts, S.W., et al. (2004). Long-term improvement of quality of life during growth hormone (GH) replacement therapy in adults with GH deficiency, as measured by questions on life satisfaction-hypopituitarism (QLS-H) [Electronic version]. The Journal of Clinical Endocrinology and Metabolism, 89(4), 1684-1693. Retrieved November 21, 2005.

Growth Hormone Replacement Therapy Appears Safe in Long Term.pdf

Rates of death, cancers, and intracranial tumor growth do not appear to be increased by growth hormone replacement therapy in adults, Mark L. Hartman, M.D., reported at the 12th International Congress of Endocrinology.
Tucker, M.E. (2004). Growth hormone replacement therapy appears safe in long term. Family Practice News, 34(21). Retrieved May 17, 2005.

Effects of Growth Hormone Replacement on Parathyroid Hormone Sensitivity and Bone Mineral Metabolism.pdf

The results of this study demonstrate that GH may have a regulatory role in bone mineral metabolism, and our data provide a possible underlying mechanism for the development of osteoporosis in AGHD patients. The changes observed after GHR may further explain the beneficial effects of GHR on bone mineral density that have consistently been reported.
Ahmad, A.M., Thomas, J., Clewes, A., Hopkins, M.T., Guzder, R., Ibrahim, H., et al. (2003). Effects of growth hormone replacement on parathyroid hormone sensitivity and bone mineral metabolism [Electronic version]. The Journal of Clinical Endocrinology and Metabolism, 88(6), 2860-2868. Retrieved December 7, 2005.

Growth Hormone Therapy in Adults.pdf

According to this review, Growth hormone (GH) is classically linked with linear growth in childhood but continues to have important metabolic actions throughout life. GH deficiency in adulthood causes a distinct syndrome with significant morbidities. These include increased total and visceral fat, decreased muscle mass and aerobic capacity, affective disturbances, abnormal lipids, and increased vascular mortality, all of which are ameliorated with GH replacement.
Cummings, D.E. & Merriam, G.R. (2003). Growth hormone therapy in adults [Electronic version]. Annual Review of Medicine, 54, 513-533. Retrieved December 7, 2005.

The Effect of Cessation of Growth Hormone (GH) Therapy on Bone Mineral Accretion in GH-Deficient Adolescents at the Completion of Linear Growth.pdf

These preliminary data suggest that, in adolescent patients with severe GHD, discontinuation of GH at completion of growth may limit the attainment of peak bone mass in this patient group. This may predispose to clinically significant osteopenia in later adult life.
Drake, W.M., Carroll, P.V., Maher, K.T., Metcalfe, K.A., Camacho-Hubner, C., Shaw, N.J., et al.  (2003). The effect of cessation of growth hormone (GH) therapy on bone mineral accretion in GH-deficient adolescents at the completion of linear growth [Electronic version]. The Journal of Clinical Endocrinology and Metabolism, 88(4), 1658-1663. Retrieved December 7, 2005.

Testosterone and Atherosclerosis.pdf

This article concludes that the overall effect of administration of testosterone on cardiovascular-disease risk is difficult to assess because androgens have such an extraordinary array of effects in vivo.
Eckardstein, A. & Wu, F.C. (2003). Testosterone and atherosclerosis [Electronic version]. Growth Hormone & IGF Research: Official Journal of the Growth Hormone Research Society and the International IGF Research Society, 13(Suppl. A), S72-84. Retrieved September 27, 2005.

American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for Growth Hormone Use in Adults and Children -- 2003 Update.pdf

This report is based on a thorough review of published studies of the safety and efficacy of GH therapy in children and adults. Summarized herein are the indications for GH use in adults and children, the conditions for which GH use has been investigated but is not approved, and the potential adverse effects of GH therapy. The authors believe that these guidelines will help clinical endocrinologists in the treatment of patients with recombinant GH.
Gharib, H., Cook, D.M., Saenger, P.H., Bengtsson, B.A., Feld, S., et al. (2003). American Association of Clinical Endocrinologists medical guidelines for clinical practice for growth hormone use in adults and children -- 2003 update [Electronic version]. Endocrine Practice: Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, 9(1), 64-76. Retrieved September 19, 2005.

Effects of Growth Hormone Secretion on Body Composition in Patients with Crohn’s Disease.pdf

This study states that although serum GH levels were similar in the two groups, GH contributed significantly to the abdominal fat measurements. These data show that GH has an important role in modulating visceral fat distribution in patients with Crohn's disease.
Katznelson, L., Fairfield, W.P., Zeizafoun, N., Sands, B.E., Peppercorn, M.A., Rosenthal, D.I., et al. (2003). Effects of Growth Hormone secretion on body composition in patients with Crohn’s disease. The Journal of Clinical Endocrinology and Metabolism, 88(11), 5468-5472. Retrieved December 7, 2005.
 

Impact of Perioperative Treatment of Recombinant Human Growth Hormone on Cell Immune Function and Intestinal Barrier Function: Randomized, Double-Blind, Controlled Trial.pdf

Twenty patients undergoing abdominal surgery participated in this placebo-controlled randomized double-blind trial.  Each patient was given human growth hormone subcutaneously for a period of days leading up to and following the operation. 
Liu, W., Jiang, Z., Wang, X., Shu, H., Cui, W. & Wilmore, D.W. (2003). Impact of perioperative treatment of recombinant human growth hormone on cell immune function and intestinal barrier function: randomized, double-blind, controlled trial [Electronic version]. World Journal of Surgery, 27(4), 412-415. Retrieved May 18, 2005.

Seeking the Optimal Target Range for Insulin-Like Growth Factor 1 During the Treatment of Adult Growth Hormone Disorders.pdf

The aim of this study was to identify a range of IGF-I values commensurate with GHD, which could be used to determine the risk of functional GHD during the treatment of adult GH disorders.
Mukherjee, A., Monson, J.P., Jonsson, P.J., Trainer, P.J. & Shalet, S.M. on behalf of KIMS International Board. (2003). Seeking the optimal target range for insulin-like growth factor 1 during the treatment of adult growth hormone disorders [Electronic version]. The Journal of Clinical Endocrinology and Metabolism, 88(12), 5865-5870. Retrieved December 7, 2005.

Cytokines, Insulin-Like Growth Factor 1, Sarcopenia, and Mortality in Very Old Community-Dwelling Men and Women: The Framingham Heart Study.pdf

This study concludes that greater levels or production of the catabolic cytokines TNF-alpha and interleukin 6 are associated with increased mortality in community-dwelling elderly adults, whereas IGF-1 levels had the opposite effect.
Roubenoff, R., Parise, H., Payette, H.A., Abad, L.W., D’Agostino, R., et al. (2003). Cytokines, insulin-like growth factor 1, sarcopenia, and mortality in very old community-dwelling men and women: the Framingham Heart Study [Electronic version]. The American Journal of Medicine, 115(6), 429-435. Retrieved September 19, 2005.

Quality of Life of Growth Hormone (GH) Deficient Young Adults During Discontinuation and Restart of GH Therapy.pdf

It is concluded that one year discontinuation of GH treatment leads to a decrease in QoL within 6 months which effect is counteracted within 6 months after restart of GH treatment.
Stouthart, P.J., Deijen, J.B., Roffel, M. & Delemarre-van de Waal, H.A. (2003). Quality of life of growth hormone (GH) deficient young adults during discontinuation and restart of GH therapy [Electronic version]. Psychoneuroendocrinology, 28(5), 612-626. Retrieved December 7, 2005.

Can Growth Hormone Prevent Aging?.pdf

This article cites the article by Rudman et al. that appeared in the Journal in 1990 that reported the effect on body composition of administering human growth hormone for six months to 12 older men. This article incited a proliferation of "antiaging" clinics and lay publications, such as "Grow Young with HGH," extolling the benefits of growth hormone in reversing or preventing aging.
Vance, M.L. (2003). Can growth hormone prevent aging? [Electronic version]. The New England Journal of Medicine, 348(9), 779-780. Retrieved October 31, 2005.

Human Growth Hormone Replacement in Adult Hypopituitary Patients: Long-Term Effects on Body Composition and Lipid Status--3-Year Results from the HypoCCS Database.pdf

Observational data confirm some important aspects of diagnosis of the adult GHD syndrome and of efficacy and safety of GH replacement.  Specifically, GH replacement therapy of GHD patients in HypoCCS induced significant long-term efficacy in terms of body composition and lipid profiles.
Attanasio, A.F., Bates, P.C., Ho, K.K., Webb, S.M., Ross, R.J., Strasburger, C.J., et al. (2002). Human growth hormone replacement in adult hypopituitary patients: long-term effects on body composition and lipid status--3-year results from the HypoCCS Database [Electronic version]. The Journal of Clinical Endocrinology & Metabolism, 87(4), 1600-1606. Retrieved January 19, 2005.

Familial Isolated Growth Hormone Deficiency is Associated with Increased Systolic Blood Pressure, Central Obesity, and Dyslipidemia.pdf

The conclusion of this study was that this genetically homogeneous isolated GHD population presents a syndrome characterized by central obesity, dyslipidemia, and elevated SBP but reduced cardiac dimensions compared with controls.
Barreto-Filho, J.A., Alcantara, M.R., Salvatori, R., Barreto, M.A., Sousa, A.C., Bastos, V., et al. (2002). Familial isolated growth hormone deficiency is associated with increased systolic blood pressure, central obesity, and dyslipidemia [Electronic version]. The Journal of Clinical Endocrinology and Metabolism, 87(5), 2018-2023. Retrieved December 7, 2005.

The Cardiovascular Risk of Adult GH Deficiency (GHD) Improved After GH Replacement and Worsened in Untreated GHD: A 12-Month Prospective Study.pdf

This study concluded that 12 months of GH replacement normalized IGF-I and improved lipid profile and cardiac performance in adult GHD patients. A similar period of GH deprivation induced a further impairment of lipid profile and cardiac performance. This finding strongly supports the need of GH replacement in adult GHD patients.
Colao, A., di Somma, C., Pivonello, R., Cuocolo, A., Spinelli, L., et al. (2002).  The cardiovascular risk of adult GH deficiency (GHD) improved after GH replacement and worsened in untreated GHD: a 12-month prospective study [Electronic version]. The Journal of Clinical Endocrinology & Metabolism, 87(3), 1088-1093. Retrieved September 26, 2005.

Shouldn't Adults with Growth Hormone Deficiency Be Offered Growth Hormone Replacement Therapy?.pdf

This analysis should encourage reluctant practitioners to at least consider growth hormone replacement therapy for patients with definite growth hormone deficiency--that is, patients with symptomatic panhypopituitarism.
Cook, D.M. (2002). Shouldn't adults with growth hormone deficiency be offered growth hormone replacement therapy? [Electronic version]. Annals of Internal Medicine, 137(3), 197-201. Retrieved September 26, 2005.

Reduced Microvascular Perfusion and Reactivity in Adult GH Deficient Patients is Restored by GH Replacement.pdf

Thirteen adult patients with severe GH-deficiency (GHD) were evaluated in this study.  The objective was to evaluate the microcirculation and vascular reactivity in a GHD state before and during GH replacement.
Hana, V., Prazny, M., Marek, J., Skrha, J. & Justova, V. (2002). Reduced microvascular perfusion and reactivity in adult GH deficient patients is restored by GH replacement [Electronic version]. European Journal of Endocrinology/European Federation of Endocrine Societies, 147(3), 333-337. Retrieved May 18, 2005.

Growth Hormone Therapy for Adults: Not Ready for Prime Time?.pdf

This article states that long-term studies in patients receiving appropriate comprehensive management for other hormonal deficiencies and for concomitant abnormalities will be required to convince physicians of the utility and safety of growth hormone replacement therapy.
Isley, W.L. (2002). Growth hormone therapy for adults: not ready for prime time? [Electronic version]. Annals of Internal Medicine, 137(3), 190-196. Retrieved September 26, 2005.

Outcomes of Growth Hormone Replacement Therapy in Survivors of Childhood Acute Lymphoblastic Leukemia.pdf

This study suggests that GH replacement therapy is safe and efficacious for the correction of GH deficiency in survivors of childhood acute lymphoblastic leukemia (ALL).
Leung, W., Rose, S.R., Zhou, Y., Hancock, M.L., Burstein, S., et al. (2002). Outcomes of growth hormone replacement therapy in survivors of childhood acute lymphoblastic leukemia [Electronic version]. Clinical Oncology, 20(13), 2959-2964. Retrieved September 26, 2005.

Inappropriate Serum Levels of IGF-I and IGFBP-3 in Patients with Rheumatoid Arthritis.pdf

In this study, it was found that the ratio of IGF-I to IGFBP-3 in RA patients was significantly lower than that in controls. These findings suggest that that an inappropriate balance of IGF-I and IGFBP-3 levels may reduce the availability of IGF-I and be involved in pathogenesis of RA.
Matsumoto, T. & Tsurumoto, T. (2002). Inappropriate serum levels of IGF-I and IGFBP-3 in patients with rheumatoid arthritis [Electronic version]. Rheumatology, 41, 352-353. Retrieved October 25, 2005.

GH-Deficient Survivors of Childhood Cancer: GH Replacement During Adult Life.pdf

This article proposes that, as in patients with hypopituitarism caused by pituitary disease, the main indication for GH replacement in GH-deficient survivors of childhood cancer should be severe impairment of quality of life.
Murray, R.D., Darzy, K.H., Gleeson, H.K. & Shalet, S.M. (2002). GH-deficient survivors of childhood cancer: GH replacement during adult life [Electronic version]. The Journal of Clinical Endocrinology & Metabolism, 87(1), 129-135. Retrieved September 26, 2005.

Reduced Capillary Permeability and Capillary Density in the Skin of GH-Deficient Adults: Improvement After 12 Months GH Replacement.pdf

A study involving seven normotensive, nondiabetic GH-deficient adults (two women) evaluated skin capillary permeability and capillary density.  It found that the growth hormone deficiency syndrome is associated with microvascular alterations, which are responsive to growth hormone replacement.
Oomen, P.H., Beentjes, J.A., Bosma, E., Smit, A.J., Reitsma, W.D. & Dullaart, R.P. (2002). Reduced capillary permeability and capillary density in the skin of GH-deficient adults: improvement after 12 months GH replacement [Electronic version]. Clinical Endocrinology (Oxford), 56(4), 519-524. Retrieved May 18, 2005.

Risk of Disease Recurrence and Second Neoplasms in Survivors of Childhood Cancer Treated with Growth Hormone: A Report from the Childhood Cancer Survivor Study.pdf

This study concludes that GH therapy does not appear to increase the risk of disease recurrence or death in survivors of childhood cancer. The increased number of SN, particularly in survivors of acute leukemia, is of concern, but the data need to be interpreted with caution given the small number of events.
Sklar, C.A., Mertens, A.C., Mitby, P., Occhiogrosso, G., Qin, J., et al. (2002). Risk of disease recurrence and second neoplasms in survivors of childhood cancer treated with growth hormone: a report from the Childhood Cancer Survivor Study [Electronic version]. The Journal of Clinical Endocrinology & Metabolism, 87(7), 3136-3141. Retrieved September 26, 2005.

Growth Hormone Treatment and Neoplasia-Coincidence or Consequence?.pdf

This special editorial by the Lawson Wilkins Pediatric Endocrine Society (LWPES) Writing Committee discusses the article by Swerdlow et al in Lancet, which reports on the risk of cancer in patients treated with human pituitary GH in the United Kingdom from 1959 to 1985.
Sperling, M.A., Saenger, P.H., Hintz, R., Wilson, T. & Rose, S.R. on behalf of the LWPES Executive Committee and the LWPES Drug and Therapeutics Committee. (2002). Growth hormone treatment and neoplasia-coincidence or consequence? [Electronic version]. The Journal of Clinical Endocrinology & Metabolism, 87(12), 5351-5352. Retrieved September 26, 2005.

Risk of Cancer in Patients Treated with Human Pituitary Growth Hormone in the UK, 1959-85: A Cohort Study.pdf

The interpretation of this study is that although based on small numbers, the risk of colorectal cancer is of some concern and further investigation in other cohorts is needed.  They have no evidence as to whether growth hormone in modern dosage regimens is associated with an increased risk of colorectal cancer.
Swerdlow, A.J., Higgins, C.D., Adlard, P. & Preece, M.A. (2002). Risk of cancer in patients treated with human pituitary growth hormone in the UK, 1959-85: a cohort study [Electronic version]. Lancet, 360(9329), 273-277. Retrieved September 26, 2005.

Oral Estrogen May Aggravate Metabolic Abnormalities in Women with Growth Hormone Deficiency.pdf

Oral administration of estrogen replacement therapy suppresses the biological actions of growth hormones (GH) in GH-deficient women, research suggests.  Findings demonstrate for the first time that the impact of oral estrogen extends beyond effects on circulating insulin growth factor I (IGF-I) levels as GH-induced stimulation of fat oxidation, protein metabolism are also affected.
(2001, November 30). Oral estrogen may aggravate metabolic abnormalities in women with growth hormone deficiency [Electronic version]. PSL Group Website. Retrieved January 19, 2006.

Critical Evaluation of the Safety of Recombinant Human Growth Hormone Administration:  Statement from the Growth Hormone Research Society.pdf

According to this study, the extensive data, to date, collected on large numbers of children and adults treated with GH indicate that for the current approved indications GH is safe. Nevertheless, this workshop has highlighted a number of areas where ongoing surveillance of the long-term safety of GH replacement is important (cancer, glucose homeostasis, high-dose pharmacological treatment). This will require appropriately designed follow-up studies using adequate epidemiological tools and untreated controls.
Critical evaluation of the safety of recombinant human growth hormone administration:  statement from the Growth Hormone Research Society [Electronic version]. (2001). The Journal of Clinical Endocrinology & Metabolism, 86(5), 1868-1870. Retrieved September 26, 2005.

Body Composition and Quality of Life in Adults with Growth Hormone Deficiency; Effects of Low-Dose Growth Hormone Replacement.pdf

This study discusses how low-dose GHR improves body composition and QoL as early as 1 month after commencement and the beneficial effects continue at 3 months. Most importantly, these changes occur in the absence of side-effects.
Ahmad, A.M., Hopkins, M.T., Thomas, J., Ibrahim, H., Fraser, W.D., et al. (2001). Body composition and quality of life in adults with growth hormone deficiency; effects of low-dose growth hormone replacement [Electronic version]. Clinical Endocrinology (Oxford), 54(6), 709-717. Retrieved September 14, 2005.

Editorial: Growth Hormone and Cardiovascular Disease:  An Area in Rapid Growth.pdf

According to this editorial, there is good evidence that GH deficiency as well as GH excess results in an increased cardiovascular risk. Because the effect of excess GH is laden with its own burden, continued critical assessment of optimal dosing becomes increasingly important with the widening use of GH therapy. Longer, prospective studies are, therefore, needed to assess the long-term risk for cardiovascular disease in GH-treated patients.
Berglund, L. & Thomas, A.M. (2001).  Editorial: Growth hormone and cardiovascular disease:  An area in rapid growth [Electronic version].  The Journal of Clinical Endocrinology & Metabolism, 86(5), 1871-1873. Retrieved September 19, 2005.

Effects of 6 Years of Growth Hormone (GH) Treatment on Bone Mineral Density in GH-Deficient Adults.pdf

This study concluded that GH therapy in GH-deficient adults is able to progressively increase BMD and bone area at the lumbar spine over a period of at least 6 years. However, the authors state that their study has several limitations, making it necessary to confirm these findings in further long-term studies.
Clanget, C., Seck, T., Hinke, V., Wuster, C., Ziegler, R. & Pfeilschifter, J. (2001). Effects of 6 years of growth hormone (GH) treatment on bone mineral density in GH-deficient adults [Electronic version]. Clinical Endocrinology (Oxf.), 55(1), 93-99. Retrieved January 18, 2006.

Improved Cardiovascular Risk Factors and Cardiac Performance After 12 Months of Growth Hormone (GH) Replacement in Young Adult Patients with GH Deficiency.pdf

This article concludes that GH replacement for 12 months significantly improved lipid profile, decreased fibrinogen levels, and increased LVMi and LVEF in young adults with co- or ao-GHD. However, lipid profile, fibrinogen levels, and systolic function remained abnormal compared with those in age- and sex-matched controls, suggesting that a longer period of GH replacement is necessary to normalize cardiovascular parameters and reverse the cardiovascular risk of these patients.
Colao, A., di Somma, C., Cuocolo, A., Spinelli, L., Tedesco, N., et al. (2001).  Improved cardiovascular risk factors and cardiac performance after 12 months of growth hormone (GH) replacement in young adult patients with GH deficiency [Electronic version].  The Journal of Clinical Endocrinology & Metabolism, 86(5), 1874-1881. Retrieved September 26, 2005.

Development and Psychometric Properties of a Disease-Specific Quality of Life Questionnaire for Adult Patients with Growth Hormone Deficiency.pdf

This article concludes that the QLS(M)-H questionnaire is concise, easy to complete, and can be effectively applied across different cultural backgrounds. Psychometric evaluation of the questionnaire reveals that it is a valid, reliable and sensitive tool useful for assessing impaired life satisfaction in adult patients with GHD and also for monitoring the efficacy of GH therapy.

Herschbach, P., Henrich, G., Strasburger, C.J., Feldmeier, H., Marin, F., et al. (2001). Development and psychometric properties of a disease-specific quality of life questionnaire for adult patients with growth hormone deficiency [Electronic version]. European Journal of Endocrinology/European Federation of Endocrine Societies, 145(3), 255-65. Retrieved September 14, 2005.
Changes in Systemic Levels of Insulin-Like Growth Factors and Their Binding Proteins in Patients with Rheumatoid Arthritis.pdf

This study concluded that increased levels of IGFBPs in RA may result in the reduced availability of free IGFs that can bind to IGF receptors. The observed changes in the IGF system may thus participate in the catabolic processes in rheumatoid arthritis.

Neidel, J. (2001). Changes in systemic levels of insulin-like growth factors and their binding proteins in patients with rheumatoid arthritis [Electronic version]. Clinical and Experimental Rheumatology, 19(1), 81-84. Retrieved October 25, 2005.

Hormonal Effects on Skin Aging.pdf

This article reviews the effect of decreasing hormone levels on the skin and the possible benefits of hormone replacement therapy (HRT).  It also discusses the positive effects Growth Hormone and estrogen can have on wound healing.
Phillips, T.J, Demircay, Z. & Sahu, M. (2001). Hormonal effects on skin aging [Electronic version]. Clinics in Geriatric Medicine, 17(4), 661-672, vi. Retrieved May 18, 2005.

Recombinant Human Growth Hormone in Patients with Acute Renal Failure.pdf

According to this study, administration of rhGH to critically ill patients with acute renal failure resulted in improvements in negative nitrogen balance and a significant decrease in total nitrogen appearance rate. These changes corresponded to increases in serum growth hormone, IGF-1, IGF-1 binding protein 3, and leptin levels after growth hormone administration.
Saadeh, E., Ikizler, T.A., Shyr, Y., Hakim, R.M. & Himmelfarb, J. (2001). Recombinant human growth hormone in patients with acute renal failure [Electronic version]. Journal of Renal Nutrition, 11(4), 212-219. Retrieved November 3, 2005.

Oral Estrogen Antagonizes the Metabolic Actions of Growth Hormone in Growth Hormone-Deficient Women.pdf

According to this study, oral estrogen antagonizes several of the metabolic actions of GH. It may aggravate body composition abnormalities already present in GHD women and attenuate the beneficial effects of GH therapy. Estrogen replacement in GHD women should be administered by a nonoral route.
Wolthers, T., Hoffman, D.M., Nugent, A.G., Duncan, M.W., Umpleby, M. & Ho, K.K. (2001). Oral estrogen antagonizes the metabolic actions of growth hormone in growth hormone-deficient women [Electronic version]. American Journal of Physiology, 281(6), E1191-1196. Retrieved January 19, 2006.

Growth Hormone Replacement in Adults with Growth Hormone Deficiency: Assessment of Current Knowledge.pdf

This article states that recent availability of recombinant human growth hormone (GH) has led to intense investigation of the consequences of adult GH deficiency (GHD) and the effects of GH replacement. These studies have led to the identification of a characteristic syndrome of GHD consisting of decreased mood and well-being, with alterations in body composition and substrate metabolism.
Carroll, P.V, Christ, E.R, & Sonksen, P.H. (2000). Growth hormone replacement in adults with growth hormone deficiency: assessment of current knowledge [Electronic version]. Trends in Endocrinology and Metabolism, 11(6), 231-238. Retrieved January 18, 2006.

Effects of 7 Years of Growth Hormone Replacement Therapy in Hypopituitary Adults.pdf

This study concludes that prolonged GH substitution in middle-aged hypopituitary adults causes a sustained improvement in body composition. Other benefits, e.g. on lipid levels and exercise tolerance, were not apparent at 7 yr when comparisons were made with GH-untreated hypopituitary controls. Potentially adverse effects on glucose tolerance and insulinemia did not develop with prolonged GH therapy.
Chrisoulidou, A., Beshyah, S.A., Rutherford, O., Spinks, T.J., Mayet, J., et al. (2000). Effects of 7 years of growth hormone replacement therapy in hypopituitary adults [Electronic version]. The Journal of Clinical Endocrinology and Metabolism, 85(10), 3762-3769. Retrieved September 14, 2005.

A Switch from Oral (2 mg/day) to Transdermal (50 microg/day) 17Beta-Estradiol Therapy Increases Serum Insulin-Like Growth Factor-I Levels in Recombinant Human Growth Hormone (GH)-Substituted Women with GH Deficiency.pdf

The results of the present study suggest that the potency of GH is altered in patients on transdermal compared to oral estradiol therapy. Further investigation should be undertaken to answer the question whether the increase in serum IGF-I levels is due to lower serum levels of estradiol or to differences in the mode of administration of estradiol.
Janssen, Y.J., Helmerhorst, F., Frolich, M. & Roelfsema, F. (2000). A switch from oral (2 mg/day) to transdermal (50 microg/day) 17beta-estradiol therapy increases serum insulin-like growth factor-I levels in recombinant human growth hormone (GH)-substituted women with GH deficiency [Electronic version]. The Journal of Clinical Endocrinology and Metabolism, 85(1), 464-467. Retrieved October 3, 2005.

Changes in Cardiac Muscle Mass and Function in Hemodialysis Patients During Growth Hormone Treatment.pdf

This study concludes that treatment with rhGH of adult chronic hemodialysis patients for 6 months increased the left ventricular mass significantly, but without any effect on ejection fraction or maximal working capacity. No electrocardiographic signs of ischemia were associated with the increasing muscle mass and only one patient developed symptoms that might relate to ischemia. No changes in B-Hb, blood pressure or pulse were observed during the treatment period.
Jensen, P.B., Ekelund, B., Nielsen, F.T., Baumbach, L., Pedersen, F.B. & Oxhoj, H. (2000). Changes in cardiac muscle mass and function in hemodialysis patients during growth hormone treatment [Electronic version]. Clinical Nephrology, 53(1), 25-32. Retrieved September 28, 2005.

Growth Hormone - Hormone Replacement for the Somatopause?.pdf

According to this article, the fall in GH secretion seen with ageing coincides with changes in body composition and lipid metabolism that are similar to those seen in adults with GH deficiency. In elderly subjects, although GH secretion is markedly reduced, remaining GH secretion correlates closely with body composition (particularly with lean body mass and inversely with central abdominal fat).
Savine, R. & Sonksen, P. (2000). Growth hormone - hormone replacement for the somatopause? [Electronic version]. Hormone Research, 53(Suppl. 3), 37-41. Retrieved January 18, 2006.

Gender Difference in Insulin-Like Growth Factor I Response to Growth Hormone (GH) Treatment in GH-Deficient Adults:  Role of Sex Hormone Replacement.pdf

The present study confirms short-term data published in the literature on a sex difference in rhGH dose requirement in GH-deficient patients. It furthers extends the data by demonstrating that this sex difference in GH responsivity persists and changes during the 24 months of the study. Moreover, it shows that estrogen replacement blunts the IGF-I response to rhGH in women, whereas in men with androgen substitution the responsivity increases over time, thus bearing a risk of undertreatment in women and overtreatment in men.
Span, J.P., Pieters, G.F., Sweep, C.G., Hermus, A.R. & Smals, A.G. (2000). Gender difference in insulin-like growth factor I response to growth hormone (GH) treatment in GH-deficient adults:  role of sex hormone replacement [Electronic version].  The Journal of Clinical Endocrinology & Metabolism, 85(3), 1121-1125. Retrieved September 26, 2005.

Interrelationships Between Growth Hormone and Sleep.pdf

This study discusses how during ageing, slow-wave (SW) sleep and GH secretion decrease exponentially and with the same chronology. Pharmacological stimulation of SW sleep results in increased GH release, and compounds that increase SW sleep may therefore represent a novel class of GH secretagogues.
Van Cauter, E. & Copinschi, G. (2000). Interrelationships between growth hormone and sleep [Electronic version]. Growth Hormone & IGF Research: Official Journal of the Growth Hormone Research Society and the International IGF Research Society, 10(Suppl. B), S57-62. Retrieved September 28, 2005.

Growth Hormone, Insulin-Like Growth Factor I and Cognitive Function in Adults.pdf

This review focuses on the possible contribution of the growth hormone (GH)-insulin-like growth factor I (IGF-I) axis to cognitive function. Effects of two years of growth hormone (GH) replacement therapy on bone metabolism and mineral density in childhood and adulthood onset GH deficient patients. 
van Dam, P.S., Aleman, A., deVries, W.R., Deijen, J.B., van der Veen, E.A., de Haan, E.H., et al. (2000). Growth hormone, insulin-like growth factor I and cognitive function in adults [Electronic version]. Growth Hormone & IGF Research: Official Journal of the Growth Hormone Research Society and the International IGF Research Society, 10(Suppl. B), S69-73. Retrieved September 28, 2005.

GH Replacement in 1034 Growth Hormone Deficient Hypopituitary Adults: Demographic and Clinical Characteristics, Dosing and Safety.pdf

The data in this study, drawn from a large population of hypopituitary adults treated with GH for a total of more than 800 patient years, confirm previous reports that untreated GHD in hypopituitary adults is associated with a number of important clinical problems.
Abs, R., Bengtsson, B.A., Hernberg-Stahl, E., Monson, J.P., Tauber, J.P. et al. (1999). GH replacement in 1034 growth hormone deficient hypopituitary adults: demographic and clinical characteristics, dosing and safety [Electronic version]. Clinical  Endocrinology (Oxford), 50(6), 703-713. Retrieved September 26, 2005.

The Effects of Treatment and the Individual Responsiveness to Growth Hormone (GH) Replacement Therapy in 665 GH-Deficient Adults. KIMS Study Group and the KIMS International Board.pdf

The data from this study highlight the value of large longitudinal surveillance databases in defining the optimum dose regimen for GH replacement and indicate that women may need a higher replacement dose of GH than men.
Bengtsson, B.A., Abs, R., Bennmarker, H., Monson, J.P., Feldt-Rasmussen, U., et al. (1999). The effects of treatment and the individual responsiveness to growth hormone (GH) replacement therapy in 665 GH-deficient adults. KIMS Study Group and the KIMS International Board [Electronic version]. The Journal of Clinical Endocrinology & Metabolism, 84(11), 3929-3935. Retrieved September 26, 2005.

Individualized Low-Dose Growth Hormone (GH) Treatment in GH-Deficient Adults with Childhood-Onset Disease: Metabolic Effects During Fasting and Hypoglycemia.pdf

In this study, GH therapy resulted in increased insulin resistance during hypoglycemia, without changes in the counterregulatory hormonal responses, serum IGFBP-1, or serum FFA.
Bulow, B., Agardh, C.D., Eckert, B. & Erfurth, E.M. (1999). Individualized low-dose growth hormone (GH) treatment in GH-deficient adults with childhood-onset disease: metabolic effects during fasting and hypoglycemia [Electronic version]. Metabolism: Clinical and Experimental, 48(8), 1003-1010. Retrieved September 14, 2005.

The Immune-Endocrine Loop During Aging: Role of Growth Hormone and Insulin-Like Growth Factor-I.pdf

This study demonstrated that IGF-I prevents apoptosis in promyeloid cells, which subsequently permits these cells to differentiate into neutrophils. It also demonstrated that IL-4 acts much like IGF-I to promote survival of promyeloid cells and to activate the enzyme phosphatidylinositol 3'-kinase (PI 3-kinase).
Burgess, W., Liu, Q., Zhou, J., Tang, Q., Ozawa, A., VanHoy, R., et al. (1999). The immune-endocrine loop during aging: role of growth hormone and insulin-like growth factor-I [Electronic version]. Neuroimmunomodulation, 6(1-2), 56-68. Retrieved September 28, 2005.

Effect of Growth Hormone (GH) and Insulin-Like Growth Factor I on Prostate Diseases: An Ultrasonographic and Endocrine Study in Acromegaly, GH Deficiency, and Healthy Subjects.pdf

This study concludes that chronic excess of GH and IGF-I cause prostate overgrowth and further phenomena of rearrangement, but not prostate cancer.
Colao, A., Marzullo, P., Spiezia, S., Ferone, D., Giaccio, A., et al. (1999). Effect of growth hormone (GH) and insulin-like growth factor I on prostate diseases: an ultrasonographic and endocrine study in acromegaly, GH deficiency, and healthy subjects [Electronic version]. The Journal of Clinical Endocrinology and Metabolism, 84(6), 1986-1991. Retrieved January 25, 2006.

Bone Loss is Correlated to the Severity of Growth Hormone Deficiency in Adult Patients with Hypopituitarism.pdf

This study concluded that a significant reduction of BMD associated with abnormalities of bone turnover parameters was found only in patients with very severe or severe GHD, whereas normal BMD values were found in non-GHD hypopituitary patients. These abnormalities were consistently present in all patients with GHD regardless of the presence of additional hormone deficits, suggesting that GHD plays a central role in the development of osteopenia in hypopituitary patients.
Colao, A., Di Somma, C., Pivonello, R., Loche, S., Aimaretti, G., Cerbone, G., et al. (1999). Bone loss is correlated to the severity of growth hormone deficiency in adult patients with hypopituitarism [Electronic version]. The Journal of Clinical Endocrinology and Metabolism, 84(6), 1919-1924. Retrieved September 28, 2005.

The Influence of Growth Hormone (GH) Deficiency and GH Replacement on Quality of Life in GH-Deficient Patients.pdf

According to this study, in contrast to virtually all aspects of metabolism, QOL is difficult to measure. Only recently have tests been developed to assess general QOL, whereas specific tests address those aspects of QOL affected only in specific situations or disease states.
Deijen, J.B. & van der Veen, E.A. (1999). The influence of growth hormone (GH) deficiency and GH replacement on quality of life in GH-deficient patients [Electronic version]. Journal of Endocrinological Investigation, 22(5 Suppl.), 127-136. Retrieved January 18, 2006.

Hypothalamo-Pituitary-Adrenal Axis and Growth Hormone Axis in Patients with Rheumatoid Arthritis.pdf

The findings of this study indicate that there is an impairment in HPA and GH axis in patients with active and remitted RA. The site of this impairment is probably hypothalamus and/or pituitary gland.
Demir, H., Kelestimur, F., Tunc, M., Kirnap, M. & Ozugul, Y. (1999). Hypothalamo-pituitary-adrenal axis and growth hormone axis in patients with rheumatoid arthritis [Electronic version]. Scandinavian Journal of Rheumatology, 28(1), 41-46. Retrieved October 25, 2005.

The Growth Hormone (GH)-Releasing Hormone-GH-Insulin-Like Growth Factor-1 Axis in Patients with Fibromyalgia Syndrome.pdf

The data from this study show that patients with FM exhibited a marked decrease in spontaneous GH secretion, but normal pituitary responsiveness to exogenously administered GHRH, thus suggesting the existence of an alteration at the hypothalamic level in the neuroendocrine control of GH in these patients. Furthermore, our finding of increased IGF-1 and IGFBP-3 levels after GH treatment, over 4 days, opens up the possibility of testing the therapeutic potential of hGH in patients with FM.
Leal-Cerro, A., Povedano, J., Astorga, R., Gonzalez, M., Silva, H., Garcia-Pesquera, F., et al. (1999). The growth hormone (GH)-releasing hormone-GH-insulin-like growth factor-1 axis in patients with fibromyalgia syndrome [Electronic version]. The Journal of Clinical Endocrinology and Metabolism, 84(9), 3378-3381. Retrieved October 31, 2005.

Effects of Two Years of Growth Hormone (GH) Replacement Therapy on Bone Metabolism and Mineral Density in Childhood and Adulthood Onset GH Deficient Patients.pdf

The aim of this study was to evaluate bone metabolism and mass before and after 2 years of GH replacement therapy in adults with childhood or adulthood onset GH deficiency. It concluded that patients with childhood or adulthood onset GH deficiency have osteopenia that can be improved by long-term treatment with GH.
Longobardi, S., Di Rella, F., Pivonello, R., Di Somma, C., Klain, M., Maurelli, L., et al. (1999). Effects of two years of growth hormone (GH) replacement therapy on bone metabolism and mineral density in childhood and adulthood onset GH deficient patients [Electronic version]. Journal of Endocrinological Investigation, 22(5), 333-339. Retrieved September 28, 2005.

Hormones and Hair Patterning in Men: A Role for Insulin-Like Growth Factor 1?.pdf

Fifty-one men over age sixty-five participated in this study.  It concludes that testosterone, sex hormone-binding globulin and IGF-1 may be important in determining hair patterning in men.
Signorello, L.B., Wuu, J., Hsieh, C., Tzonou, A., Trichopoulos, D. & Mantzoros, C.S. (1999). Hormones and hair patterning in men: a role for insulin-like growth factor 1? [Electronic version]. Journal of the American Academy of Dermatology, 40(2 Pt. 1), 200-203. Retrieved May 24, 2005.

Insulin-Like Growth Factor 1 and Hair Growth.pdf

This article discusses that Insulin-like growth factor 1 (IGF-1) has been identified as an important growth factor in many biological systems and how IGF-1 may be able to stimulate the proliferation of hair follicle cells through cellular signaling pathways of its receptors.
Su, H.Y., Hickford, J.G., Bickerstaffe, R. & Palmer, B.R. (1999). Insulin-like growth factor 1 and hair growth [Electronic version]. Dermatology Online Journal, 5(2), 1. Retrieved May 24, 2005.

Effects of 42 Months of GH Treatment on Bone Mineral Density and Bone Turnover in GH-Deficient Adults.pdf

This study concluded that GH treatment in GH-deficient adults increased BMD for up to 30-36 months, with a plateau thereafter. Concurrently with the plateau in BMD the bone turnover rate normalized. From the skeletal point of view GH-deficient patients exhibiting osteopenia or osteoporosis should be considered as candidates for GH supplementation of at least 3-4 years.
Valimaki, M.J., Salmela, P.I., Salmi, J., Viikari, J., Kataja, M., Turunen, H., et al. (1999). Effects of 42 months of GH treatment on bone mineral density and bone turnover in GH-deficient adults [Electronic version]. European Journal of Endocrinology/European Federation of Endocrine Societies, 140(6), 545-554. Retrieved September 28, 2005.

Consensus Guidelines for the Diagnosis and Treatment of Adults with Growth Hormone Deficiency: Summary Statement of the Growth Hormone Research Society Workshop on Adult Growth Hormone Deficiency.pdf

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.
(1998). Consensus guidelines for the diagnosis and treatment of adults with growth hormone deficiency: summary statement of the Growth Hormone Research Society Workshop on adult growth hormone deficiency [Electronic version]. The Journal of Clinical Endocrinology and Metabolism, 83(2), 379-381. Retrieved September 28, 2005.

Growth Hormone Deficiency in Adulthood and the Effects of Growth Hormone Replacement: A Review.pdf

The importance of GH throughout adult life is now unequivocally accepted.  GH deficiency is recognized to result in alterations in body composition, physical performance, psychological well-being, and substrate metabolism.  Many of these alterations can be improved or corrected with GH replacement.  The prospect of GH replacement becoming routine, however, does raise a number of issues.
Carroll, P.V., Christ, E.R., Bengtsson, B.A., Carlsson, L., Christiansen, J.S., et al.  (1998). Growth hormone deficiency in adulthood and the effects of growth hormone replacement: A review [Electronic version]. The Journal of Clinical Endocrinology & Metabolism, 83(2), 382-395. Retrieved May 17, 2005.

Effect of Long-Term Growth-Hormone Substitution Therapy on Bone Mineral Density and Parameters of Bone Metabolism in Adult Patients with Growth Hormone Deficiency.pdf

This study concluded that GH replacement therapy in adult patients with GHD over a period of 18 months causes a pronounced increase in bone turnover mainly during the first 12 months of therapy and increases BMD of the lumbar spine and the femoral neck after 18 months.
Kotzmann, H., Riedl, M, Bernecker, P., Clodi, M., Kainberger, F., Kaider, A., et al. (1998).  Effect of long-term growth-hormone substitution therapy on bone mineral density and parameters of bone metabolism in adult patients with growth hormone deficiency [Electronic version]. Calcified Tissue International, 62(1), 40-46. Retrieved January 18, 2006.

Growth Hormone and Mild Exercise in Combination Markedly Enhance Cortical Bone Formation and Strength in Old Rats.pdf

The effects of a combination of mild exercise and GH injections on bone were studied in old female rats. This study showed that GH injections and mild excercise in combination modulate and increase further the formation and strength of cortical bone in old female rats.
Oxlund, H., Andersen, N.B., Ortoft, G., Orskov, H. & Andreassen, T.T. (1998). Growth hormone and mild exercise in combination markedly enhance cortical bone formation and strength in old rats [Electronic version]. Endocrinology, 139(4), 1899-1904. Retrieved September 28, 2005.

Effect of Growth Hormone Therapy in Burn Patients on Conservative Treatment.pdf

This study observed thirteen patients with second and third degree burns who received recombinant human growth hormone (rhGH) for two weeks in addition to standard conservative treatment and nine patients who were managed with standard conservative treatment only.  The observations suggest significant benefits of short term rhGH treatment in burn patients on conservative management.
Singh, K.P., Prasad, R., Chari, P.S. & Dash, R.J. (1998). Effect of growth hormone therapy in burn patients on conservative treatment [Electronic version]. Burns: Journal of the International Society for Burn Injuries, 24(8), 733-8. Retrieved May 17, 2005.

Two Years of Replacement Therapy in Adults with Growth Hormone Deficiency.pdf

A large group of human growth hormone (hGH) deficient adults received human growth hormone (hGH) replacement therapy for two years.  The study confirmed that human growth hormone (hGH) supplementation and modulation created beneficial effects on body composition, metabolic parameters and improvement on a general sense of well-being.
Verhelst, J., Abs, R., Vandeweghe, M., Mockel, J., Legros, J.J., Copinschi, G., et al. (1997). Two years of replacement therapy in adults with growth hormone deficiency [Electronic version]. Clinical Endocrinology (Oxford), 47(4), 485-494. Retrieved July 25, 2003.

No Evidence for Involvement of the Growth Hormone/Insulin-Like Growth Factor-1 Axis in Psoriasis.pdf

Psoriasis patients took part in this study to determine whether altering the growth hormone/insulin-like growth factor-1 axis plays a role in the pathogenesis of psoriasis.
Bjorntorp, E., Wickelgren, R., Bjarnason, R., Swanbeck, G., Carlsson, L.M. & Lindahl, A. (1997). No evidence for involvement of the growth hormone/insulin-like growth factor-1 axis in psoriasis [Electronic version]. The Journal of Investigative Dermatology, 109(5), 661-665. Retrieved May 18, 2005.

Growth Hormone Substitution in Adult Growth Hormone-Deficient Men Augments Androgen Effects on the Skin.pdf

This study included forty-six adult men with childhood-onset of growth hormone deficiency.  Twenty-five of the participants were androgen-deficient and received replacement.  The conclusion of the study was that for growth hormone-deficient men, growth hormone substitution therapy has an auxiliary effect on androgen action in the skin without an increase of the free androgen index.
Blok, G.J., de Boer, H., Gooren, L.J. & van der Veen, E.A. (1997). Growth hormone substitution in adult growth hormone-deficient men augments androgen effects on the skin.  Clinical Endocrinology (Oxford), 47(1), 29-36. Retrieved May 24, 2005.

A Preliminary Study of Growth Hormone in the Treatment of Dilated Cardiomyopathy.pdf

This study concludes that recombinant human growth hormone administered for three months to patients with idiopathic dilated cardiomyopathy increased myocardial mass and reduced the size of the left ventricular chamber, resulting in improvement in hemodynamics, myocardial energy metabolism, and clinical status.
Fazio, S., Sabatini, D., Capaldo, B., Vigorito, C., Giordano, A., Guida, R., et al. (1996). A preliminary study of growth hormone in the treatment of dilated cardiomyopathy [Electronic version]. The New England Journal of Medicine, 334(13), 809-814. Retrieved September 27, 2006.

Recombinant Human Growth Hormone Treatment at Low Doses Does Not Significantly Change Thyroid Function in Growth Hormone Deficient Adults.pdf

In this study, all parameters (except IGF1) did not show any variation during and after rhGH treatment at low doses. The alterations of T3 and T4 metabolism, in the sense of a T3 increase and a T4 reduction, caused sometimes by rhGH treatment, could be due to the higher doses used and therefore should be considered another side effect, like artrhalgia, fluid retention, carpal tunnel syndrome, etc.
Amato, G., Izzo, G., Salzano, I & Bellastella, A. (1996). Recombinant human growth hormone treatment at low doses does not significantly change thyroid function in growth hormone deficient adults [Electronic version]. Journal of Endocrinological Investigation, 19(8), 563-566. Retrieved September 28, 2005.

Effects of Physiologic Growth Hormone Therapy on Bone Density and Body Composition in Patients with Adult-Onset Growth Hormone Deficiency. A Randomized, Placebo-Controlled Trial.pdf

According to this study, growth hormone administered to men with adult-onset growth hormone deficiency at a dose adjusted according to serum IGF-1 levels increases bone density and stimulates bone turnover, decreases body fat and increases lean mass, and is associated with a low incidence of side effects.
Baum, H.B., Biller, B.M., Finkelstein, J.S., Cannistraro, K.B., Oppenhein, D.S., Schoenfeld, D.A., et al. (1996). Effects of physiologic growth hormone therapy on bone density and body composition in patients with adult-onset growth hormone deficiency. A randomized, placebo-controlled trial [Electronic version]. Annals of Internal Medicine, 125(11), 883-890. Retrieved September 28, 2005.

Insulin-Like Growth Factor-I (Somatomedin C) Levels in Chronic Fatigue Syndrome and Fibromyalgia.pdf

These findings of this study suggest the disruption of the growth hormone-IGF-I axis previously demonstrated in FM patients is not evident in a referral population of patients with CFS, CFS-FM, or FM.
Buchwald, D., Umali, J. & Stene, M. (1996). Insulin-like growth factor-I (somatomedin C) levels in chronic fatigue syndrome and fibromyalgia [Electronic version]. The Journal of Rheumatology, 23(4), 739-742. Retrieved November 1, 2005.

Increase of Bone Mineral Density and Anabolic Variables in Patients with Rheumatoid Arthritis Resistant to Methotrexate After Cyclosporin A Therapy.pdf

This study concluded that patients with active RA, even in the early phases, lose bone very rapidly. Effective control of systemic inflammation allowed a rapid rescue of BMD, at least in the short term. This happened with a simultaneous increase in some anabolic variables such as IGF-1, BGP, and DHEAS.
Ferraccioli, G., Casatta, L. & Bartoli, E. (1996). Increase of bone mineral density and anabolic variables in patients with rheumatoid arthritis resistant to methotrexate after cyclosporin A therapy [Electronic version]. The Journal of Rheumatology, 23(9), 1539-1542. Retrieved October 25, 2005.

Two Years of Growth Hormone (GH) Treatment Increases Bone Mineral Content and Density in Hypopituitary Patients with Adult-Onset GH Deficiency.pdf

According to this study, two years of GH treatment induced a sustained increase in overall bone remodeling activity, which resulted in a net gain in BMD that was more marked in those subjects with a low pretreatment z-score.
Johannsson, G., Rosen, T., Bosaeus, I., Sjostrom, L. & Bengtsson, B.A.. (1996). Two years of growth hormone (GH) treatment increases bone mineral content and density in hypopituitary patients with adult-onset GH deficiency [Electronic version]. The Journal of Clinical Endocrinology and Metabolism, 81(8), 2865-2873. Retrieved January 18, 2006.

Growth Hormone Substitution in Growth Hormone-Deficient Adults: Effects on Collagen Type I Synthesis and Skin Thickness.pdf

The purpose of this study was to prove whether stimulating collagen type I synthesis would be accompanied by a deposition of collagen type I in the skin.  It examined twenty growth hormone-deficient hypopituitary patients for twelve months.
Kann, P., Piepkorn, B., Schehler, B., Lotz, J., Prellwitz, W. & Beyer, J. (1996). Growth hormone substitution in growth hormone-deficient adults: effects on collagen type I synthesis and skin thickness [Electronic version]. Experimental and Clinical Endocrinology & Diabetes: Official Journal, German Society of Endocrinology [and] German Diabetes Association, 104(4), 327-333. Retrieved May 18, 2005.

Body Composition and Tissue Distributions in Growth Hormone Deficient Adults Before and After Growth Hormone Treatment.pdf

Computed tomography was used to examine the short and long-term effects of recombinant human growth hormone (rhGH) on body composition and regional tissue distributions in this two-part study.  Its findings look at Adipose tissue, muscle and visceral organs.
Lonn, L., Johansson, G., Sjostrom, L., Kvist, H., Oden, A. & Bengtsson, B.A. (1996). Body composition and tissue distributions in growth hormone deficient adults before and after growth hormone treatment [Electronic version]. Obesity Research, 4(1), 45-54. Retrieved May 18, 2005.

Consequences of Growth Hormone Deficiency in Adults and the Benefits and Risks of Recombinant Human Growth Hormone Treatment. A Review Paper.pdf

According to this study, growth hormone deficiency (GHD) in adults is now recognized as a specific clinical syndrome with characteristic symptoms and signs. Thus, the patients are overweight, have an abnormal body composition (excess body fat and a decrease in the extracellular water volume) and a low bone mineral content compared to normals.
Rosen, T., Johannsson, G., Johansson, J.O. & Bengtsson, B.A. (1995). Consequences of growth hormone deficiency in adults and the benefits and risks of recombinant human growth hormone treatment. A review paper [Electronic version]. Hormone Research, 43(1-3), 93-99. Retrieved January 25, 2006.