608 1005-2194 2011 08-0608 - 05 R584. 2 A GHD GH GH GHD GH GHD ITT GHRH + GH- RH + GHRP ITT GHD rh- GH Interpretation of guidelines on the diagnosis and treatment of adults with growth hormone deficiency. CEN Jing GU Feng. Key Laboratory of Endocrinology of the Ministry of Health Department of Endocrinology Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100730 China Summary Adult growth hormone deficiency GHD mainly defined by a series of nonspecific clinical manifestations and relevant biomarkers is well-recognized as structural or functional damage in hypothalamus and / or pituitary gland. Due to pulsatile secretion of growth hormone GH and variations among random population differentiation of patients with GHD and normal individuals should not be made simply depending on the level of GH. The well-acknowledged insulin tolerance test ITT remains the gold standard for diagnosis of GHD in a- dults and it is not until recently when the combination of growth hormone releasing hormone GHRH and arginine test as well as the combination of GHRH with growth hormone releasing peptide GHRP and glucagon stimulating test are considered to share similar diagnostic value with ITT. Multiple complications are common in adults with GHD among which chronic cardiovascular complications might be the chief cause for increased mortality rate. Recombinant human growth hormone rhgh replacement therapy could improve most of the clinical endpoint events including elevation of quality of life and reduction in the risk of cardiovascular events. Keywords Growth hormone deficiency in adult guidelines 1996 FDA 2009 4 rhgh GHD 20 GHD rhgh 1-3 2004 GHD GHD 100730 gufeng1025@ yahoo. com. cn
2011 8 31 8 609 1 GHD GHD 1. 2 /100 000 ~ 1. 65 /100 000 4 2. 3. 1 GH GHD GHD GH GH GH GHD GHD GHRP GHRH 3 1 GHD 50% GHD GHD GHD GH 2 2 GHD ITT GHRH + GHRH + GHRP ITT 30% ~ 60% GHD 1 1 5 GH 50% 10 GHD 3 3 3 GHD -1 IGF-1 97% GH 4 GHRH 2 GHD 2. 1 GHD GHRH + GH 1 GH < 0. 4 μg /L 3 2. 3. 2 IGF-1 IGF-1 GHD 1 - IGF-1 GHD 2 GH IGF-1 3 4 < 40 BMI < 25 GHD 3 GHD IGF-1 2. 2 GHD GHD IGF-1 GH 1-3 IGFBP-3 GHD 3 LDL-C HDL- C 2 GHD rhgh GHD 20% GHD T < - 2. 5 IGF- 1 6 GHD 3. 1 2 ~ 5 3 GHD GHD rhgh 2 1-1 2 GHDITT GH < 3 μg /L 2. 3 GH GH 3 GHD QoL 4
610 1 2 GH 5 ITT 1 GH < 3 μg /L 100% 2 97% 2 - - GH 0. 1 ~ 0. 15 U /kg 15 - - min 1 BMI 2. 2 mmol /L GH GHRH + BMI < 25 GH < 11 μg /L BMI 25 ~ 30 GH < 8 μg /L BMI > 30 GH < 4 μg /L GHD GHRH 1 95% 3 91% 3 BMI μg /kg 30 min GHRH 0. 5 g /kg 30 g L- 0 15 30 45 60 90 120 min GH GHRH + GHRP-6 GH < 10 μg /L GHRH GHRP-6 GHRH 1 μg /kg 100% 100% GHRP-6 1 μg /kg 0 15 30 45 60 90 120 min GH GH < 3 μg /L > 48 h 1 mg 97% ~ 1. 5 mg > 90 kg 100% 0 30 60 90 120 150 BMI - 180 210 240 min GH 88% ~ 100% 1 GH 2 GH < 5 μg /L 3 GH < 4. 1 μg /L GH 0 3. 3. 2 11-β -1 GH GHD rhgh FDA IGF-1 3. 2 GHD rhgh 2 0. 2 mg /d 0. 3 mg /d 0. 1 mg /d 6 3. 3. 3 TSH GH T 4 4 ~ 6 h 20 ~ 24 h T 3 GH T 4 rhgh 3 7 3 3. 3 3. 3. 1 GHD GH rhgh rhgh rhgh GH 8 rh- 3. 4 rhgh GHD GH 1 GH 6 GH rhgh 3. 3. 4 GHD rhgh IGF-1 2
2011 8 31 8 611 rhgh 12 BMD GHD 1 ~ 2 BMD 4% ~ 10% 6 3 2 9 4 rhgh 3. 6 GHD rhgh QoL BMI IFG-1 3. 5 rhgh 0. 1 ~ 0. 2 mg /d GHD GH 1 ~ 2 5% ~ 18% 1 ~ 2 2 GHD rhgh rhgh rhgh 1 2 2 2 GHD rhghg rhgh rhgh rhgh rhgh - rhgh - rhgh GHD GH rhgh rhgh 4 4. 1 GHD - - GHD 1 - - rhgh 1 GHD QoL GH 4. 2 rhgh - rhgh - GHD rhgh GHD GHD rhgh 2 IGF-1 rhgh BMI X DEXA 1 3 ~ 6 BMI 2 6 ~ 12 GHD X 1 ~ 2 QoL 3 12 IGF-1 IGF-1 4 2 6 IGF-1 GH 3 rhgh
612 - - - - GHD rhgh 1 GHD rhgh GHD rhgh 1 GHD rhgh IGF-1 1 GHD 1 Molitch ME Clemmons DR Malozowski S et al. Evaluation and treatment of adult growth hormone deficiency an Endocrine Society Clinical Practice Guideline J. J Clin Endocrinol Metab 2006 91 5 1621-1634. 2 Ho KK. Consensus guidelines for the diagnosis and treatment of a- dults with GH deficiency Ⅱ a statement of the GH Research Society in association with the European Society for Pediatric Endocrinology Lawson Wilkins Society European Society of Endocrinology Japan Endocrine Society and Endocrine Society of Australia J. Eur J Endocrinol 2007 157 6 695-700. 3 Cook DM Yuen KC Biller BM et al. American Association of Clinical Endocrinologists medical guidelines for clinical practice for growth hormone use in growth hormone-deficient adults and transition patients Suppl 2 1-29. - 2009 update J. Endocr Pract 2009 15 4 Stochholm K Gravholt CH Laursen T et al. Mortality and GH deficiency a nationwide study J. Eur J Endocrinol 2007 157 1 9-18. 5 Yuen KC Biller BM Molitch ME et al. Clinical review Is lack of recombinant growth hormone GH -releasing hormone in the United States a setback or time to consider glucagon testing for adult GH deficiency J. J Clin Endocrinol Metab 2009 94 8 2702-2707. 6 Giavoli C Libe R Corbetta S et al. Effect of recombinant human growth hormone GH replacement on the hypothalamic-pituitaryadrenal axis in adult GH-deficient patients J. J Clin Endocrinol Metab 2004 89 11 5397-5401. 7 Porretti S Giavoli C Ronchi C et al. Recombinant human GH replacement therapy and thyroid function in a large group of adult GH-deficient patients when does L-T 4 therapy become mandatory J. J Clin Endocrinol Metab 2002 87 5 2042-2045. 8 Clemmons DR. The relative roles of growth hormone and IGF-1 in controlling insulin sensitivity J. J Clin Invest 2004 113 1 25-27. 9 Svensson J and Bengtsson BA. Safety aspects of GH replacement J. Eur J Endocrinol 2009 161 Suppl 1 S65-74. 2011-05 - 06