Overview
Adult growth hormone deficiency (GHD) is characterized by inadequate secretion of growth hormone leading to metabolic and physiological impairments, including cardiovascular complications. Long-term replacement therapy with growth hormone (GH) can improve cardiac parameters and reduce markers of heart failure 1.Diagnosis
Clinical Symptoms: Fatigue, decreased muscle mass, increased body fat, impaired cardiovascular health 1.
Laboratory Tests: Measure insulin-like growth factor-1 (IGF-1) levels and confirm deficiency through provocative testing (e.g., insulin tolerance test, glucagon stimulation test) 1.
Echocardiography: Assess left ventricular dimensions and function, noting initial slight increases in interventricular septum diameter (IVSD) and left ventricular mass index (LVMi) 1.
NT-proBNP Levels: Elevated levels indicative of potential heart failure risk; baseline levels >125 ng/L are significant predictors 1.Management
First-Line Treatment: Growth hormone replacement therapy, aiming for normalization of IGF-1 levels (typically within ±1 SD of age-adjusted mean) 1.
Monitoring: Regular assessment of IGF-1 levels every 3-6 months and echocardiographic parameters annually 1.
Cardiac Markers: Monitor NT-proBNP levels to evaluate response and potential cardiac benefits 1.Special Populations
Cardiac Considerations: Patients with elevated baseline NT-proBNP levels may particularly benefit from GH replacement, showing significant declines in NT-proBNP levels 1.Key Recommendations
Initiate growth hormone replacement therapy in adults with confirmed GHD to normalize IGF-1 levels (Evidence: Strong 1).
Regularly monitor NT-proBNP levels and echocardiographic parameters to assess cardiovascular health and treatment efficacy (Evidence: Moderate 1).
Target IGF-1 levels within ±1 SD of age-adjusted mean to optimize therapeutic outcomes (Evidence: Expert opinion 1).References
1 Ziagaki A, Blaschke D, Haverkamp W, Plöckinger U. Long-term growth hormone (GH) replacement of adult GH deficiency (GHD) benefits the heart. European journal of endocrinology 2019. link