Filipsson Helena, Johannsson Gudmundur
Department of Endocrinology, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg University, Sweden.
Eur J Endocrinol. 2009 Nov;161 Suppl 1:S85-95. doi: 10.1530/EJE-09-0319. Epub 2009 Aug 14.
Severe GH deficiency (GHD) in adults has been described as a clinical entity. However, some of the features associated with GHD could be due to unphysiological and inadequate replacement of other pituitary hormone deficiencies. This may be true for glucocorticoid replacement that lacks a biomarker making dose titration and monitoring difficult. Moreover, oral estrogen replacement therapy decreases IGF1 levels compared with the transdermal route, which attenuates the responsiveness to GH replacement therapy in women. In addition, in untreated female hypogonadism, oral estrogen may augment the features associated with GHD in adult women. Important interactions between the hormones used for replacing pituitary hormone deficiency occur. Introducing GH replacement may unmask both an incipient adrenal insufficiency and central hypothyroidism. Therefore, awareness and proper monitoring of these hormonal interactions are important in order to reach an optimal replacement therapy. This review will focus on the complex hormonal interactions between GH and other pituitary hormones in GHD and in GH replacement.
成人严重生长激素缺乏症（GHD）已被描述为一种临床实体。然而，一些与GHD相关的特征可能归因于其他垂体激素缺乏的非生理性和不充分替代。对于缺乏生物标志物、使得剂量滴定和监测困难的糖皮质激素替代而言，可能确实如此。此外，与经皮途径相比，口服雌激素替代疗法会降低IGF1水平，这会减弱女性对生长激素替代疗法的反应性。另外，在未经治疗的女性性腺功能减退中，口服雌激素可能会加重成年女性中与GHD相关的特征。用于替代垂体激素缺乏的激素之间会发生重要的相互作用。引入生长激素替代可能会揭示出潜在的肾上腺功能不全和中枢性甲状腺功能减退。因此，为了实现最佳替代疗法，了解并适当监测这些激素相互作用非常重要。本综述将聚焦于生长激素缺乏症及生长激素替代中生长激素与其他垂体激素之间复杂的激素相互作用。
