Clinical management of growth hormone therapy in adults.

GH replacement is an effective and rational therapy for adult men and women with known pituitary disease or risk factors for hypopituitarism; for example, severe head trauma or pituitary irradiation, provided that GHD is proven. Only at-risk adults should be tested, and adults with childhood GHD should be retested before prescribing GH for adult needs. A neuroendocrine review should be considered in all cases of TBI and SAH. The AACE, Endocrine Society, and GRS have issued detailed GHD treatment guidelines. Diagnostic evaluations should follow these guidelines, and physicians should stay abreast of changing information about testing cut-points and the use of IGF-1 as a marker for GHD. The pros and cons of GH treatment must be discussed with each patient, after which GH doses should be individualized and titrated to maximum efficacy with minimal side effects. Off-label use of GH therapy as an anti-aging treatment or sports enhancement is clearly at odds with current guidelines and should not be prescribed under any circumstances. GH replacement therapy has been shown to improve the clinical features of GHD in adults, although there yet have been no studies on endpoints such as cardiovascular events, fractures, and death. When used in an approved and ethical fashion for the defined population, this treatment can enhance the health and well-being of the many patients who suffer from the complications of GHD.