Consensus guidelines for the diagnosis and treatment of adults 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.

The GH Research Society held a Consensus Workshop in Sydney, Australia, 2007 to incorporate the important advances in the management of GH deficiency (GHD) in adults, which have taken place since the inaugural 1997 Consensus Workshop. Reported in Eur J Endocrinol. 2007 Dec;157(6):695-700.

The workshop participants concluded: Testing for GHD should be extended from hypothalamic–pituitary disease and cranial irradiation to include traumatic brain injury. Testing may indicate isolated GHD; however, idiopathic isolated GHD occurring de novo in the adult is not a recognized entity. The insulin tolerance test, combined administration of GHRH (growth hormone releasing hormone) with arginine or growth hormone-releasing peptide, and glucagon are validated GH stimulation tests in the adult. A low IGF-I is a reliable diagnostic indicator of GHD in the presence of hypopituitarism, but a normal IGF-I does not rule out GHD. GH status should be reevaluated in the transition age for continued treatment to complete somatic development. Interaction of GH with other axes may influence thyroid, glucocorticoid, and sex hormone requirements. Response should be assessed clinically by monitoring biochemistry, body composition, and quality of life. There is no evidence that GH replacement increases the risk of tumor recurrence or de novo malignancy.

IGF-I measurements in the diagnosis of adult growth hormone deficiency. Kwan AY, Hatman ML. Pituitary 2007, 10(2): 151-7. US Medical Division, Lilly Research Laboratories, Elo, Hartman ML. Pituitary. 2007;10(2):151-7. US Medical Division, Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Drop Code 5015, Indianapolis, IN, 46285, USA, hartman@lilly.com.

Although serum insulin-like growth factor I (IGF-I) concentrations have utility as a screening test for growth hormone (GH) deficiency in children and young adults, they are less accurate for screening in adults over 40 years of age. There are two main limitations in the clinical use of IGF-I levels as a marker of GH secretion. First, IGF-I synthesis is not only regulated by GH but also by nutrient supply and by other hormones; second, low IGF-I levels in the presence of normal or increased GH secretion may reflect a peripheral resistance to GH action. Although serum IGF-I cannot be used as a stand-alone test for the diagnosis of adult GH deficiency, very low IGF-I levels in the context of documented hypothalamic or pituitary disease may be helpful in identifying patients with a high probability of GH deficiency. In the presence of two or more additional pituitary hormone deficiencies, an IGF-I level <84 mug/l (assayed by Esoterix Endocrinology, Inc. Calabasas Hills, CA, USA) indicates a 99% probability of GH deficiency. As this cut-off value has not been validated for other IGF-I assays, an IGF-I standard deviation score (SDS) of <-3 may be considered in adults over age 28; an even lower IGF-I SDS is needed for diagnosis in younger adults. In clinical practice, other causes of low serum IGF-I such as malnutrition, diabetes, hypothyroidism, liver disease, etc., should be excluded before applying these diagnostic criteria.

Conditional Cardiovascular Response to Growth Hormone Therapy in Adult Patients with Prader-Will Syndrome (PWS). Reported in theJournal of Clinical Endocrinology and Metabolism, April 2007, 92(4):1364-1371.

On January 20, 2007, clinical investigators in Italy reported that altered GH secretion has been related to reduced cardiac mass and function. Upon evaluating cardiovascular response to GH secretion in PWS adults, they found that GH therapy increased cardiac mass without disastolic consequences; but they observed a slight deterioration of right heart function and an association between IGF-I and left-venricular function, which they concluded requires appropriate cardiac and hormonal monitoring .

Consensus Statement: Management of Children Born Small-for-Gesational Age (SGA) through Adulthood. Reported in theJournal of Endocrinology and Metabolism, March 2007, 92(3):804-810.

On January 2, 2007, the International Societies of Pediatric Endocrinology and the Growth Hormone Research Society issued a consensus statement containing the following conclusions: The diagnosis of SGA should be based on accurate birth measurements for weight, length, and head circumference. There should be early surveillance in growth clinics for the children without catch-up growth; and, early neurodevelopment evaluation and intervention for at-risk children. For the 10 percent of SGA children who lack catch up growth, growth hormone (rhGH) can increase linear growth. Long term surveillance of treated children is required. Associations between low birth weight, including SGA, and coronary heart disease and stroke in later life are recognized, but there is presently insufficient evidence to recommend surveillance of all adults born SGA.

Clinical Practice Guideline: Care of Girls and Women with Turner Syndrome (TS). Reported in theJournal of Endocrinology and Metabolism, January 2007, 92(1):10-25.

On October 25, 2006, The Turner Syndrome Consensus Study Group, consisting of an international group of premier endocrinologists in the area of TS, issued a "Guideline" for the care of girls and women with TS. The Guidelines highlight the need for diagnosis, monitoring, and preventative care relating to cardiovascular defects; early identification of potential attention-deficit or non-verbal learning disorders; lifetime monitoring of hearing and thyroid hormone funcction; and the monitoring of adults for aortic enlargement, hypertension, diabetes, and dyslipidemia; open discussion of premature ovarian failure and the importance of estrogen treatment for feminization and bone health. The Study Group also recommended that puberty should not be delayed to promote statural growth; but recognized that most girls with TS are now treated with growth hormone
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