The psychological changes associated with GH deficiency have been extensively studied. Patients who develop GH deficiency seem to lose energy. Loss of energy is often the guiding symptom which prompts further investigation. Many individuals with pituitary disease, especially those with other hormone deficiencies, realize that something is missing. Frequently, it turns out to be a deficiency of GH. Individuals with this problem, or their spouses, also notice a loss of interest in their usual hobbies or activities. A decrease in sociability referred to as social isolation is another symptom. Patients suffering with this symptom do not like to go out and meet with their friends or social acquaintances. Patients may also develop mild depression or decrease in sexual function.

HGH deficiency shares MANY of the same symptoms of Cushing's. A decrease in the level of growth hormone in adults may result in:

• weakened heart muscle contraction and heart rate
• increased arterial plaque and blood pressure
• elevated lipids or fats in the blood:
• cholesterol
• low density lipoproteins (LDL)
• triglycerides
• decreased exercise capacity due to decreased cardiac output
• decreased energy due to decreased metabolic rate
• abnormal body composition:
  • increased abdominal obesity (waist to hip ratio)
  • decreased bone density due to decreased synthesis of bone
  • increase in fractures and osteoporosis
  • decreased muscle strength and muscle size
  • decreased lean body mass
  • increased fat mass
• problem with sleep quality
• decreased social contact
• symptoms of low blood sugar:
  • weakness or tiredness
  • headaches
  • poor concentration or memory

From GH Deficiency

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There are other ways the physician will monitor GH therapy. If the patient has a pituitary tumor, an MRI will be performed before therapy begins and usually every year thereafter. It is not known whether or not GH can stimulate the growth of residual tumors. The endocrinologist physician will decide when and how often this should be performed. The physician will often elect to monitor blood cholesterol and bone density. Successful therapy is associated with an increase in the density of bones and an improvement in blood cholesterol profile.

From GH Deficiency

This information was developed by David Cook, M.D. It is not intended to substitute for a full and frank consultation with qualified medical personnel, which is the primary means for a patient to obtain care and treatment. The information was believed to be current on November 5, 1998 and with the lapse of time, certain of this material will be outdated.

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Growth hormone deficiency must be diagnosed with a stimulation test (blood test after receiving a stimulating medication). The most common stimulation tests include: insulin to lower the blood sugar, L-dopa, arginine and growth hormone releasing hormone. The maximum GH level after the stimulating medication is used to determine if a patient is growth hormone deficient.

Growth hormone must be administered by an injection under the skin once a day. The needle used is a very tiny insulin needle (GH deficient children give themselves this injection daily). Growth hormone replacement must be monitored by assessing the clinical response, assessment of side effects and by measuring the blood IGF-1 level to determine if the dose is correct for a patient (one dose doesn't fit all when it comes to hormone replacement therapy).

Growth hormone replacement is FDA approved for patients who have pituitary disease and who have an abnormal stimulation test. It is expensive, usually more than $10,000/year. Thus, most insurance companies require documentation of the need for this medication and the results of the stimulation test before agreeing to reimbursement.

The answer to this question about pituitary tumors was developed by Mary Lee Vance, M.D., Professor of Medicine and Neurosurgery at the University of Virginia. Dr. Vance is an endocrinologist specializing in the treatment of pituitary diseases.

For more information from Dr Vance, see Pituitary Tumors Frequently Asked Questions

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