Many plans would only cover growth hormone for adults if there is pituituary or hypothalamic disease and other hormone replacemetn is being delivered, or severe growth deficincy (peak response less than 3mg/ml during an insulin tolerance test), impairment of quality of life. These criteria ensure that appropraite investigtions are carried out and that low ICF levels are not treated cavalierly.
Acquired growth hormone (GH) deficiency results from the destruction of normal pituitary and/or hypothalamic tissue, usually from a tumor or secondary to surgical and/or radiation therapy. Diagnostic criteria and clinical sequelae of GH deficiency, although well established in children, are currently areas of active investigation in the adult.Growth hormone deficiency is an important cause of excess morbidity and even mortality. Evidence from a number of smaller studies indicates that GH replacement will improve body composition, lipid metabolism, bone density, cardiovascular function and psychological well being. Important issues remaining are the precise clinical definition of partial vs. complete GH deficiency in such patients and clarifying the best tests to make this diagnosis.
The insulin tolerance test (ITT) or the growth hormone releasing hormone (GHRH)-arginine test is the preferred test for establishing the diagnosis of GHD. However, in those with clearly established recent hypothalamic causes of suspected GHD (e.g. irradiation) testing with GHRH-arginine may be misleading (level of evidence, high). Thiese condtions are not rpesent in this case.
The Endocrine Society. Evaluation and treatment of adult growth hormone deficiency: an Endocrine Society clinical practice guideline. Chevy Chase (MD): Endocrine Society; 2006. 33 p. [166 references]
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