Growth Hormone Deficiency in Adults


Book Description

It has been known for over 40 years that GH-deficient-children benefit from replacement with the hormone. But GH, essential for longitudinal growth, also plays a role after completion of final height. With the introduction of biosynthetic human GH 20 years ago, the use of GH was no longer restricted to severe growth retardation in hypopituitary children. This book will take the reader behind the myths of GH and into the real world of clinical endocrinology. The contributions stem from recognized clinicians and scientists who have been working in the field for decades. The contents encompass traditional end points of GH therapy such as body composition, bone biology and physical performance. Attention is also devoted to diagnostic aspects and side effects. Additional features range from clinical epidemiology to quality of life, and novel areas such as the impact of traumatic brain injury on pituitary function are also covered. The present volume of Frontiers of Hormone Research is essential reading for health care professionals interested in clinical endocrinology and GH.







Gigantism and Acromegaly


Book Description

Gigantism and Acromegaly brings together pituitary experts, taking readers from bench research, to genetic analysis, clinical analysis, and new therapeutic approaches. This book serves as a reference for growth hormone over-secretion and its diagnosis and treatment for endocrinologists, pediatricians, internists, and neurosurgeons, and for geneticists. Pharmaceutical companies may use it as a reference for drug development and research. Students, residents and fellows in medicine and endocrinology and genetics will also find it valuable as it provides a single up-to-date review of the molecular biology of gigantism and acromegaly as well as recommended approaches to evaluation and management. Acromegaly is a rare pituitary disorder that slowly changes its adult victim's appearance over time: larger hands and feet, bigger jaw, forehead, nose, and lips. Generally, a benign pituitary tumor is the cause and symptoms of acromegaly can vary from patient to patient, making a diagnosis difficult and prolonging suffering for years. Early detection is key in the management of acromegaly as the pathologic effects of increased growth hormone (GH) production are progressive and can be life-threatening as the result of associated cardiovascular, cerebrovascular, and respiratory disorders and malignancies. - Accessible, up-to-date overview of the characteristics, state-of-the-art diagnostic procedures, and management of acromegaly and gigantism - Provides a unique compendium of endocrinology, genetics, clinical diagnosis and therapeutics - Contains contributions from internationally known experts who have treated patients with acromegaly and gigantism







New Insights and Controversies in Diagnosis and Treatment of Adult Growth Hormone Deficiency


Book Description

Adult growth hormone deficiency (aGHD) is the clinical expression of a reduced GH secretion caused by congenital or acquired diseases affecting the hypothalamus-pituitary axis. Once considered a rare clinical disorder, its prevalence is apparently increasing. Nevertheless, due to the subtle clinical manifestations, aGHD could be still underestimated. Thirty years of experience with recombinant GH (rh-GH) clearly indicate the beneficial effects of replacement therapy with amelioration of metabolic and inflammatory parameters, body composition, endothelial function, quality of life, and reduction of cardiovascular risk. Furthermore, the world of GH and aGHD is rapidly enriching: new information on GH physiology, regarding its metabolic role and pleiotropic activities, is spreading, thus even making inappropriate the same name of “growth hormone”. The definition of “functional” and “partial” aGHD is still unclear and debated, although data about partially impaired GH secretion showed alteration of some metabolic and clinical parameters associated with cardiovascular risk. Current guidelines about GHD diagnosis and treatment have been elaborated, but many questions remain debated. New tests for diagnosis have recently been proposed, and non-conventional indications for diagnosis and treatment deserve further investigations. Controlled trials on the beneficial effects on morbidity and mortality are still lacking and new formulations of GH are under investigation. Several questions are related to the age of affected patients (from transition age to ageing) and no indications are available on how long the therapy should be considered. Other concerns are related to a possible pro-oncogenic effect, especially in patients who develop the deficiency after a removal of a hypothalamic-pituitary tumor. The interrelations with other pituitary axes need further clarification since isolate GHD and multiple pituitary deficiencies may have a different spectrum of manifestation. The aim of this Research Topic is to furnish deeper insight to questions related to aGHD: from molecular pathways involved in the pathophysiology to diagnostic tools and replacement therapy.




Growth Hormone in Adults


Book Description

This revised new edition reviews the substantial advances in our understanding of the vital role of growth hormone (GH) in maintaining adult health, and the resulting disorders from GH deficiency. The first edition, published in 1996, provided a pioneering overview of the subject; this new edition provides an even more comprehensive account, fully updated with the latest research, clinical applications, and references. The therapeutic benefits of GH treatment in GH deficiency are thoroughly evaluated, including effects on metabolism, cardiac function, exercise performance, psychosocial aspects, and aging and gender-specific effects. This compilation by the world's leading experts covers clinical investigation, diagnosis and treatment issues, and encompasses new knowledge of the control and action of GH secretion. This volume is the most authoritative, comprehensive, and detailed account available and will be an essential source of reference for all endocrinologists.




Growth Hormone And The Heart


Book Description

Growth Hormone and the Heart endeavors to bring together knowledge that has been accumulated in the area of GH and the heart, from basic to clinical studies, by research groups working on this topic throughout the world. Lessons from different experimental models and from several human diseases (acromegaly, adult GH deficiency, heart failure) suggest to endocrinologists and cardiologists that GH may not only have a role in the physiology and pathophysiology of heart function, but that GH itself may have a place in the treatment of primary heart diseases (such as dilated cardiomyopathy) or of cardiac complications of hypopituitarism. Growth Hormone and the Heart will be a useful update of the research produced in the field of cardiovascular endocrinology. The Editors also hope that this book will serve as the primary step in the recognition of the wide physiological and clinical significance of GH and heart interactions.




Clinical Rounds in Endocrinology


Book Description

This book on pediatric endocrinology covers interesting and yet often challenging cases among pediatric patients in a unique Question-Answer format. Simulating the bed-side case discussions during the ward rounds, one question logically leads to another, thereby generating curiosity and promoting evidence-based medicine. Taking the readers through the entire spectrum starting from etiology and pathophysiology to clinical presentation to management principles, each question addresses one key aspect of the disorder. Described in a very simple and lucid narrative, this book ensures sound conceptual understanding while covering each topic comprehensively. This volume covers important topics such as short stature, pubertal disorders, thyroid disorders, childhood Cushing syndrome, rickets and osteomalacia, disorder of sexual differentiation and diabetes in the young. Less common disorder such as multiple endocrine neoplasia has also been incorporated. These cases are not only seen by endocrinologists, but are also managed by paediatricians, internists, obstetricians and gynaecologists, orthopaedicians and surgeons.







Growth Hormone Therapy in Pediatrics


Book Description

For 20 years, KIGS (Pfizer International Growth Database) has provided an outstanding tool for monitoring the use, efficacy and safety of growth hormone (GH) treatment in children with short stature of varying origin. This volume offers a comprehensive update of the continuing experiences in KIGS and is based on data from more than 50 countries and more than 60,000 patients. International experts analyse in detail the basic auxological characteristics of patients and their response to GH treatment for a broad spectrum of growth disorders. These include idiopathic GH deficiency, organic GH deficiency due to a variety of causes such as congenital malformations and syndromes, genetic disorders or treatment for leukaemia or central nervous system tumours and short stature in children born small for gestational age, specific syndromes and systemic disorders. Each growth disorder is also covered by a review of relevant published data by international experts. KIGS has also established itself as a primary source of information about adverse events during long-term GH treatment in children. The recent analysis of KIGS data has revealed no new adverse drug reactions since the 10-year follow-up. Therefore, treatment with GH seems a low-risk intervention in children and adolescents with various growth disorders. The process of developing disease-specific growth response prediction models has been ongoing in KIGS for many years. The available models are accurate, precise and have a relatively high degree of predictive power, although further predictors of the growth response remain to be identified. The KIGS prediction models can be applied prospectively to new patients, enabling their GH therapy to be better tailored and monitored to achieve optimal growth, safety and cost outcomes. The future of KIGS within the era of evidence-based medicine will continue to depend upon the quality of the data reported. Therefore, the commitment of participating physicians will continue to be a decisive element. The ongoing recognition of the importance of valid safety and efficacy information in the practice of paediatric endocrinology is exemplified by this valuable international collaboration of clinicians and the pharmaceutical community.