THERAPY OF ENDOCRINE DISEASE: Growth hormone replacement therapy in adults: 30 years of personal clinical experience
Publikation: Bidrag til tidsskrift › Review › Forskning › fagfællebedømt
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THERAPY OF ENDOCRINE DISEASE : Growth hormone replacement therapy in adults: 30 years of personal clinical experience. / Jørgensen, Jens O L; Juul, Anders.
I: European Journal of Endocrinology, Bind 179, Nr. 1, 2018, s. R47-R56.Publikation: Bidrag til tidsskrift › Review › Forskning › fagfællebedømt
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TY - JOUR
T1 - THERAPY OF ENDOCRINE DISEASE
T2 - Growth hormone replacement therapy in adults: 30 years of personal clinical experience
AU - Jørgensen, Jens O L
AU - Juul, Anders
N1 - © 2018 European Society of Endocrinology.
PY - 2018
Y1 - 2018
N2 - The acute metabolic actions of purified human growth hormone (GH) were first documented in adult hypopituitary patients more than 50 years ago, and placebo-controlled long-term GH trials in GH-deficient adults (GHDA) surfaced in 1989 with the availability of biosynthetic human GH. Untreated GHDA is associated with excess morbidity and mortality from cardiovascular disease and the phenotype includes fatigue, reduced aerobic exercise capacity, abdominal obesity, reduced lean body mass, osteopenia and elevated levels of circulating cardiovascular biomarkers. Several of these features reverse and normalize with GH replacement. It remains controversial whether quality of life, assessed by questionnaires, improves. The known side effects are fluid retention and insulin resistance, which are reversible and dose dependent. The dose requirement declines markedly with age and is higher in women. Continuation of GH replacement into adulthood in patients with childhood-onset disease is indicated, if the diagnosis is reconfirmed. GH treatment of frail elderly subjects without documented pituitary disease remains unwarranted. Observational data show that mortality in GH-replaced patients is reduced compared to untreated patients. Even though this reduced mortality could be due to selection bias, GH replacement in GHDA has proven beneficial and safe.
AB - The acute metabolic actions of purified human growth hormone (GH) were first documented in adult hypopituitary patients more than 50 years ago, and placebo-controlled long-term GH trials in GH-deficient adults (GHDA) surfaced in 1989 with the availability of biosynthetic human GH. Untreated GHDA is associated with excess morbidity and mortality from cardiovascular disease and the phenotype includes fatigue, reduced aerobic exercise capacity, abdominal obesity, reduced lean body mass, osteopenia and elevated levels of circulating cardiovascular biomarkers. Several of these features reverse and normalize with GH replacement. It remains controversial whether quality of life, assessed by questionnaires, improves. The known side effects are fluid retention and insulin resistance, which are reversible and dose dependent. The dose requirement declines markedly with age and is higher in women. Continuation of GH replacement into adulthood in patients with childhood-onset disease is indicated, if the diagnosis is reconfirmed. GH treatment of frail elderly subjects without documented pituitary disease remains unwarranted. Observational data show that mortality in GH-replaced patients is reduced compared to untreated patients. Even though this reduced mortality could be due to selection bias, GH replacement in GHDA has proven beneficial and safe.
KW - Body Composition
KW - Bone Diseases, Metabolic/etiology
KW - Exercise Tolerance
KW - Hormone Replacement Therapy
KW - Human Growth Hormone/deficiency
KW - Humans
KW - Hypopituitarism/complications
KW - Insulin Resistance
KW - Obesity, Abdominal/etiology
KW - Quality of Life
KW - Recombinant Proteins/therapeutic use
KW - Treatment Outcome
KW - Water-Electrolyte Imbalance/chemically induced
U2 - 10.1530/EJE-18-0306
DO - 10.1530/EJE-18-0306
M3 - Review
C2 - 29716978
VL - 179
SP - R47-R56
JO - European Journal of Endocrinology
JF - European Journal of Endocrinology
SN - 0804-4643
IS - 1
ER -
ID: 218468069