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Hypopituitarism and Growth Hormone Deficiency in Adults

  • Sofia LlahanaEmail author
  • Anne Marland
  • Mila Pantovic
  • Vera Popovic
Chapter

Abstract

Pituitary conditions are associated with several physical, psychological, and social symptoms. Treatment involves surgery, medical treatment, and/or radiotherapy. Most patients with pituitary conditions have permanent hypopituitarism (congenital or acquired) and require lifelong hormone replacement therapy. Polypharmacy with multiple daily dosing and complex treatment regimens are common and patients may often require more than five different medications daily.

The treatment goal is to achieve normal physiological hormone levels with minimal side effects and to avoid adverse effects associated with deficiency or over-replacement. Growth hormone (GH) deficiency is very common in adults with hypopituitarism and requires replacement with daily subcutaneous injections. A provocative stimulation test is required to establish the diagnosis of GH deficiency in adults with the insulin tolerance test being regarded as the “gold standard”. Individualised selection of a suitable injecting device is important in improving adherence to medication and optimal replacement. Treatment with GH in adults improves quality of life, body composition, and bone density. Long-acting GH formulations are in development and aim to improve adherence and convenience with treatment via weekly or monthly injections.

Keywords

Hypopituitarism Pituitary disorders Growth hormone deficiency Hormone replacement therapy Daily injections Quality of life 

Abbreviations

ACTH

Adreno-corticotropic hormone

ADH

Antidiuretic hormone

DI

Diabetes insipidus

FSH

Follicle-stimulating hormone

GH

Growth hormone

GHRH

GH-releasing hormone

GST

Glucagon stimulation test

IGF-1

Insulin-like growth factor-1

ITT

Insulin tolerance test

LAGH

Long-acting growth hormone

LH

Luteinising hormone

PRL

Prolactin

QoL

Quality of life

rhGH

Recombinant human growth hormone

TSH

Thyroid-stimulating hormone

Notes

Acknowledgments

Special thanks to Pat McBride, Head of Patient and Family Services, The Pituitary Foundation (https://www.pituitary.org.uk), for her contribution to this chapter with case studies, patient resources, and information on the Patient Advocacy Group

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Key Reading

  1. 1.
    Burt MG, Ho KKY. Chapter 11 - Hypopituitarism and growth hormone deficiency. In: Jameson JL, de Groot LJ, de Kretser DM, Giudice LC, Grossman AB, Melmed S, Potts JT, Weir GC, editors. Endocrinology: adult and pediatric. 7th ed. Philadelphia: W.B. Saunders; 2016.Google Scholar
  2. 2.
    Clayton PE, Cuneo RC, Juul A, Monson JP, Shalet SM, Tauber M. Consensus statement on the management of the GH-treated adolescent in the transition to adult care. Eur J Endocrinol. 2005;152:165–70.Google Scholar
  3. 3.
    Fleseriu M, Hashim IA, karavitaki N, Melmed S, Murad MH, Salvatori R, Samuels MH. Hormonal replacement in hypopituitarism in adults: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016;101:3888–921.PubMedGoogle Scholar
  4. 4.
    Molitch ME, Clemmons DR, Malozowski S, Merriam GR, Vance ML. Evaluation and treatment of adult growth hormone deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96:1587–609.PubMedGoogle Scholar
  5. 5.
    Toogood AA, Stewart PM. Hypopituitarism: clinical features, diagnosis, and management. Endocrinol Metab Clin North Am. 2008;37:235–61.PubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Sofia Llahana
    • 1
    Email author
  • Anne Marland
    • 2
  • Mila Pantovic
    • 3
  • Vera Popovic
    • 4
  1. 1.School of Health Sciences, CityUniversity of LondonLondonUK
  2. 2.Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of MedicineUniversity of OxfordOxfordUK
  3. 3.Department of Neuroendocrinology, Clinic for EndocrinologyClinical Center SerbiaBelgradeSerbia
  4. 4.Medical FacultyUniversity of BelgradeBelgradeSerbia

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