Canadian guidelines for the management of adult growth hormone deficiency
Ur, E.; Serri, O.; Legg, K.; Murphy, L.J.; Ezzat, S.
Clinical and Investigative Medicine 29(2): 83-90
2006
ISSN/ISBN: 0147-958X PMID: 16737084 Document Number: 605065
Purpose: To develop guidelines for the management of growth hormone (GH) deficiency in Canadian adults to facilitate rational use of GH in appropriate indications.Methods: The guidelines were developed by group of endocrinologists and an endocrine specialist nurse with an interest in neuroendocrine disorders, representing all regions of Canada and practicing in a variety of settings. A steering committee with broad expertise undertook a systematic review of the evidence relating to adult GHD and GH replacement. This evidence was reviewed by the whole group, and guidelines were developed using a consensus approach.Results: The document addresses the causes and clinical characteristics of GHD in adults and reviews the evidence in support of GH replacement in this group. The authors provide recommendations for the identification of adult GHD, and guidelines for GH replacement in appropriate patients. Also, access to GH therapy across Canada is reviewed.Growth hormone deficiency (GHD) in adults has been a subject of increasing interest in the past two decades. Evidence has accumulated of the adverse consequences of adult GHD, as well as of the benefits of long-term growth hormone (GH) replacement. The use of GH in adults in clinical practice is expanding and widespread concern has been raised about ethical and pharmacoeconomic issues relating to its use and misuse in different clinical and non-clinical scenarios. Such concerns are accentuated by the lack of clear-cut national guidelines, and the authors believe that the development of such guidelines will facilitate rational use of GH in appropriate indications.These guidelines were developed by a consensus group of endocrinologists and an endocrine specialist nurse with an interest in neuroenclocrine disorders, representing all regions of Canada and practicing in a variety of settings. A steering committee with broad expertise (the authors of this document) undertook a systematic review of the evidence relating to adult GHD and GH replacement. This evidence was reviewed by the whole group, and guidelines were developed using a consensus approach. The document addresses the causes and clinical characteristics of GHD in adults, and reviews the evidence in support of GH replacement in this group. The authors provide recommendations for the identification of adult GHD, and guidelines for GH replacement in appropriate patients. The paper also reviews access to GH therapy across Canada.Emphasis was placed on newer diagnostic and management strategies with the understanding that adult GHD is a distinct patho-physiological entity not related to the physiological GH decline associated with normal aging. In this context GH is increasingly suggested as a potential treatment for age-related frailty, osteoporosis, morbid obesity, cardiac failure, and various catabolic conditions. The available placebo controlled studies in these contexts have not reported significant beneficial effects. The use of GH for non-GH deficient subjects as part of an anti-aging regiment is strongly discouraged since there are no human studies that indicate efficacy in this regard. Moreover, compelling data from animal studies suggests that lower GH levels are positively correlated with longevity whereas higher GH levels are associated with a shortened life-span.(1).