An overview of the controversies of adult growth hormone deficiency diagnosis.

INTRODUCTION

Growth hormone (GH) not only drives growth but also has significant metabolic, structural, and quality-of-life impacts. While GH deficiency (GHD) in childhood impairs growth, in adulthood, it leads to metabolic syndrome and multisystem functional abnormalities, collectively termed adult GHD syndrome. Despite being recognized for decades, adult GHD syndrome continues to pose diagnostic and therapeutic challenge.

AREAS COVERED

The aim of this review is to analyze the main controversies that persist in diagnosing adult GHD more than 30 years after the initial studies demonstrating the existence of GHD syndrome in adulthood.

EXPERT OPINION

The only reliable method for diagnosing adult GHD is demonstrating the failure of GH levels to rise above a specific threshold following pharmacological stimulation tests. Various tests are available, and the choice of the most appropriate one depends on the clinical context, the presence of potential contraindications, and the availability of specific pharmacological agents. It is also important to note that the reproducibility of some stimulation tests for diagnosing adult GHD has been questioned. The GH cutoff values considered diagnostic for GHD differ depending on the test used, are significantly influenced by the individual's body composition and age as well as by assay method employed.