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hyposomatotropism (growth hormone deficiency)
Etiology:
- congenital
- acquired
- most common pituitary disorder after traumatic brain injury, neurosurgical intervention for pituitary tumor, or cranial irradiation [1]
- isolated, idiopathic adult-onset GH deficiency is rare [1]
- component of hypopituitarism
- functional: emotional deprivation syndrome
Clinical manifestations:
- children
- short stature, dwarfism
- adults
- decreased muscle mass
- decreased muscle strength is common
- increased adipose tissue
- diminished bone mineral density
- diminished endurance is common
- diminished sense of well being
Laboratory:
- serum IGF1 [1]
- growth hormone stimulation test
- serum growth hormone levels are pulsatile & undetectable for much of the day in most patients [1]
- see ARUP consult [2]
Management:
1) adults: start human growth hormone 200-300 ug SQ QD
2) increment by 200 ug at monthly intervals
3) adjust to maintain serum IGF-1 levels in midnormal range
4) women receiving oral estrogens require higher doses [2]
Specific
growth hormone deficiency isolated type 1A; pituitary dwarfism I (IGHD1A)
growth hormone deficiency isolated type 1B; dwarfism of Sindh (IGHD1B)
growth hormone deficiency isolated type 2; dwarfism of Sindh (IGHD1B)
General
hypopituitarism
References
- Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18.
American College of Physicians, Philadelphia 2009, 2012, 2015, 2018.
- ARUP Consult: Growth Hormone Deficiency
The Physician's Guide to Laboratory Test Selection & Interpretation
https://www.arupconsult.com/content/growth-hormone-deficiency
- Kreitschmann-Andermahr I, Poll EM, Reineke A et al
Growth hormone deficient patients after traumatic brain
injury-baseline characteristics and benefits after growth
hormone replacement-an analysis of the German KIMS database.
Growth Horm IGF Res. 2008 Dec;18(6):472-8
PMID: 18829359