Overview
Adult-onset growth hormone deficiency (GHD) is characterized by inadequate secretion of growth hormone in adults, often leading to metabolic disturbances and increased cardiovascular risk 1.Diagnosis
Elevated fasting remnant-like particle cholesterol (RLP-C) levels 1.
Impaired postprandial RLP-C concentrations and increased incremental area under the curve for RLP-C 1.
Reduced flow-mediated dilatation (FMD) indicating compromised endothelial function 1.
Diagnosis typically involves assessing GH secretion through provocative tests (e.g., insulin tolerance test, glucagon stimulation test) 1.Management
First-line treatment: Recombinant human growth hormone (rh-GH) therapy 1.
Duration and monitoring: Treatment duration and dose should be individualized, with monitoring of metabolic parameters and endothelial function 1.
Adjunctive therapies: Consider addressing comorbidities such as dyslipidemia with appropriate pharmacological interventions 1.Special Populations
Elderly: No specific data provided in the abstract; management should focus on cardiovascular risk reduction alongside GH replacement 1.
Comorbidities: Patients with premature atherosclerosis may benefit from GH therapy to improve lipid profiles and endothelial function 1.Key Recommendations
Initiate recombinant human growth hormone (rh-GH) therapy in adults with confirmed GHD to improve metabolic parameters and endothelial function (Evidence: Moderate) 1.
Monitor postprandial remnant-like particle cholesterol (RLP-C) concentrations and flow-mediated dilatation (FMD) to assess treatment efficacy (Evidence: Moderate) 1.
Consider rh-GH therapy in elderly patients with GHD, focusing on cardiovascular risk reduction, though further evidence is needed (Evidence: Expert opinion) 1.References
1 Twickler TB, Wilmink HW, Schreuder PC, Cabezas MC, van Dam PS, Koppeschaar HP et al.. Growth hormone (GH) treatment decreases postprandial remnant-like particle cholesterol concentration and improves endothelial function in adult-onset GH deficiency. The Journal of clinical endocrinology and metabolism 2000. link