A 2024 Update on Growth Hormone Deficiency Syndrome in Adults: From Guidelines to Real Life

Abstract

Background: Adult growth hormone deficiency (GHD) has been recognized since the late 1980s. The clinical manifestations of adult GHD are often nonspecific, and diagnosis relies on GH stimulation tests, which are intricate, costly, time-consuming, and may carry the risk of adverse effects. Diagnosis is further complicated by factors like age, sex, and BMI, which affect GH response during testing. Therefore, GH replacement therapy remains challenging, requiring careful individualized evaluation of risks and benefits. The aim of this review is to provide an update on diagnosing and treating adult GHD, addressing current limitations and challenges based on recent studies. Methods: We conducted a comprehensive review of the literature regarding the diagnosis and management of adult GHD by searching PubMed and EMBASE. Only articles in English were included, and searches were conducted up to August 2024. Results: A review of guidelines and literature up to 2024 highlights the significant heterogeneity in the data and reveals various protocols for managing GHD, covering both diagnostic and therapeutic approaches. Conclusions: Despite diagnostic and treatment advances, managing adult GHD remains challenging due to variable presentation and the need for personalized GH therapy. Future efforts should aim to improve and standardize diagnostic and treatment protocols.

Keywords: adult; clinical guidelines; diagnosis; growth hormone deficiency; hormone replacement therapy; stimulation tests; treatment protocols.

Figure 1

Management of GHD in adults (original figure). BMI, body mass index; DEXA, Dual-Energy X-ray Absorptiometry; DM, diabetes mellitus; GDM, gestational diabetes mellitus; Oes, oral estrogen; QoL, quality of life; rhGH, recombinant human GH.