Doga M, Bonadonna S, Gola M, Mazziotti G, Giustina A
Endocrine Section, Department of Medical and Surgical Sciences, University of Brescia, Brescia, Italy.
Pituitary. 2006;9(4):305-11. doi: 10.1007/s11102-006-0410-y.
Growth hormone deficiency (GHD) in adults may be of either adult or childhood onset and may occur as isolated GHD or as multiple hormone deficiencies. Adult-onset GHD (AoGHD) usually results from damage to the pituitary gland or hypothalamus. GH is frequently undetectable in normal subjects and thus GHD cannot be distinguished from the normal state using a single random GH measurement. In general, a stimulation test is required to recognize GHD. Insulin tolerance test (ITT) has been considered the gold standard by the most important scientific societies, although alternative tests, in particular GHRH plus arginine have been proposed as valuable alternative to ITT. The clinical syndrome associated with AoGHD is characterized by a wide array of symptoms and important chronic complications, such as cardiovascular complications, which may be responsible for an increased mortality. The rationale for GH replacement in adults GHD patients is justified by the beneficial effects on some clinical end-points, such as quality of life (QoL) and cardiovascular risk factors, whereas the effects on mortality risk are still controversial. Over the recent years, guidelines on the use of rhGH as a substitution treatment in adult hypopituitarism have been issued by international (Growth hormone research society-GRS, Endocrine Society) and relevant national (National Institute of Clinical Excellence-UK, NICE) institutions. The aim of the paper is to review and discuss these guidelines.
成人生长激素缺乏症（GHD）可能始于成人期或儿童期，可表现为孤立性GHD或多种激素缺乏。成人起病的GHD（AoGHD）通常由垂体或下丘脑受损引起。在正常受试者中，生长激素（GH）常常检测不到，因此无法通过单次随机GH测量将GHD与正常状态区分开来。一般来说，需要进行刺激试验来诊断GHD。胰岛素耐量试验（ITT）被最重要的科学学会视为金标准，尽管也有人提出了替代试验，特别是生长激素释放激素（GHRH）加精氨酸试验，可作为ITT的有价值替代方法。与AoGHD相关的临床综合征具有一系列症状和重要的慢性并发症，如心血管并发症，这可能导致死亡率增加。对成年GHD患者进行GH替代治疗的依据是其对一些临床终点具有有益影响，如生活质量（QoL）和心血管危险因素，而对死亡风险的影响仍存在争议。近年来，国际（生长激素研究学会 - GRS、内分泌学会）和相关国家（英国国家临床优化研究所 - NICE）机构已发布了关于使用重组人生长激素（rhGH）作为成人垂体功能减退替代治疗的指南。本文旨在回顾和讨论这些指南。
