Monitoring of insulin-like growth factors during growth hormone treatment: adulthood growth hormone deficiency.

Decisions on growth hormone (GH) dosing in paediatric practice have depended on body weight or surface area calculations. Although this policy was used initially in the treatment of adult patients, it has become apparent both in clinical studies and longitudinal observation that this results in relative overtreatment of male patients, with a high incidence of immediate side effects, and undertreatment of females. Use of individualized GH dosing against serum IGF-I has proven useful in optimizing therapy across the whole adult age range, including the elderly and in patients who are in transition from post-puberty to full somatic development. It also eliminates gender differences in susceptibility. In this respect, serum IGF-I is superior to other GH-dependent peptides. However, on present evidence, serum IGF-I should be regarded primarily as a safety marker rather than a specific therapeutic marker.