Today the American Association of Clinical Endocrinologists (AACE) released new medical guidelines for the accurate diagnosis and effective ethical treatment of growth hormone deficiency in affected patients.
Growth hormone replacement therapy has proven useful for children and adults with scientifically proven growth hormone deficiency. In recent years, however, growth hormone use for anti-aging and athletic enhancement has increased to the point that this use currently accounts for approximately 30 percent of growth hormone prescriptions in the United States. A number of professional athletes have now admitted or have been alleged to have used HGH to speed recovery from injury or to enhance performance. Anti-aging centers tout benefits of HGH to slow the aging process.
"Although there is not a wealth of medical data published concerning HGH as a recovery tool for injured athletes, it's certainly not an approved indication for use," Dr. David Cook, Interim Division Chief of Endocrinology at the Oregon Health & Science University, and co-author of the new medical guidelines said.
In addition to addressing the increasing misuse of growth hormone in anti-aging and sports, the AACE guidelines more importantly address the accurate diagnosis and effective therapy for growth hormone deficient patients, as well as new cut points or benchmarks for growth hormone testing.
"These guidelines are the result of recent advancements in our understanding of the benefits of growth hormone replacement for patients," Dr. Cook said.
Responsiveness to growth hormone therapy is often determined by many variables, such as age, sex, adiposity, and concurrent medications. However, even after accounting for these variables, there remain highly individual differences in the response to growth hormone.
"Controlled trials, using strict dosing regimes and measuring clinical end points, such as body composition and insulin sensitivity, have shown us that growth hormone dosing should be individualized, with close attention to avoiding side effects," Dr. Cook said.
The AACE guidelines also outline new cut points for stimulation testing of growth hormone deficiency. Stimulation testing measures normal secretion or low growth hormone secretion, making them an accurate barometer to gauge growth hormone deficiency.
"If the cut point is five and the highest response is four, then the patient is growth hormone deficient," Dr. Cook said. "Some tests also depend upon body mass index such as the Arginine + growth hormone releasing hormone stimulation test."
Despite a growing body of evidence on the benefits of growth hormone therapy, there is still considerable inconsistency in the United States in the clinical practice of growth hormone replacement for adults.
"There are multiple factors accounting for this," Dr. Cook said. "Such as the high cost of growth hormone therapy, the need for daily injections, the lack of awareness regarding its indications, diagnosis, long-term surveillance, and concerns about whether there are long-term risks involved."
Consequences of untreated growth hormone deficiency include cardiovascular complications, metabolic complications, osteopenia/osteoporosis, and diminished quality of life.