Departments of Neuroendocrinology and Neurosurgery, Barrow Pituitary Center, Barrow Neurological Institute, University of Arizona College of Medicine and Creighton School of Medicine, Phoenix, Arizona, USA.
Eur J Endocrinol. 2021 Apr;184(4):C5-C7. doi: 10.1530/EJE-20-1455.
Adult growth hormone deficiency (GHD) is a syndrome characterized by adverse phenotypic, metabolic, and quality-of-life features. Over the past 2 decades, there is accumulating evidence demonstrating improvement of most of these parameters when GH is optimally replaced. Appropriate selection of patients at risk of GHD is crucial when considering and performing testing to establish the diagnosis. While generally safe, GH replacement requires careful dose initiation and monitoring to assure effectiveness and tolerance in treated patients. Several consensus clinical practice guidelines recommend evaluation of adults presenting with hypothalamic-pituitary disorders for GHD. However, the clinical practice of managing such patients varies among countries largely due to lack of recognition of the condition, lack of GH availability, and lack of reimbursement of the drug, as demonstrated from a large online survey prepared by the European Society of Endocrinology involving 2148 patients from Europe and Australia. These data reinforce the notion of the large variability of disease recognition, clinical practice and education of adult GHD amongst healthcare professionals, and the lack of availability and reimbursement of the drug contributing to the under-utilization of GH replacement therapy in several countries. This commentary article highlights the fact that despite the publication of several guideline recommendations and positive long-term safety and efficacy data of GH replacement, there is still a need for increased education to enhance the awareness in the general population and improve the knowledge of healthcare professionals and administrators of adult GHD as a disease state to allow for early identification and treatment optimization.
成人生长激素缺乏症（GHD）是一种以不良表型、代谢和生活质量特征为特征的综合征。在过去的 20 年中，有越来越多的证据表明，当 GH 得到最佳替代时，大多数这些参数都得到了改善。在考虑进行测试以确立诊断时，适当选择有 GHD 风险的患者至关重要。虽然 GH 替代通常是安全的，但需要谨慎地开始和监测剂量，以确保治疗患者的有效性和耐受性。一些共识临床实践指南建议评估患有下丘脑-垂体疾病的成年人是否存在 GHD。然而，由于对这种疾病缺乏认识、缺乏 GH 供应以及缺乏药物报销，各国在管理这些患者的临床实践方面存在很大差异，这一点从欧洲内分泌学会准备的一项大型在线调查中可以看出，该调查涉及来自欧洲和澳大利亚的 2148 名患者。这些数据强化了这样一种观点，即疾病的认识、临床实践和成人 GHD 的教育在医疗保健专业人员中存在很大差异，而且药物的供应和报销不足导致在几个国家中 GH 替代治疗的使用率较低。本文强调了一个事实，即尽管已经发布了几项指南建议以及 GH 替代的长期安全性和疗效数据，但仍需要加强教育，以提高公众的认识，并提高医疗保健专业人员和成人 GHD 管理人员对这种疾病状态的认识，以实现早期识别和治疗优化。
