Contents

Search

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] - since isolated, idiopathic adult-onset GH deficiency is rare, do not test unless history of hypothalamic or pituitary disease, surgery or radiation therapy to sella tursica or proximity, head trauma, other pituitary hormone deficiencies 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

  1. Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18. American College of Physicians, Philadelphia 2009, 2012, 2015, 2018. - Medical Knowledge Self Assessment Program (MKSAP) 20 American College of Physicians, Philadelphia 2025
  2. ARUP Consult: Growth Hormone Deficiency The Physician's Guide to Laboratory Test Selection & Interpretation https://www.arupconsult.com/content/growth-hormone-deficiency
  3. 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
  4. Tritos NA, Biller BMK. Current concepts of the diagnosis of adult growth hormone deficiency. Rev Endocr Metab Disord. 2021;22:109-116. PMID: 32959175