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.
