Adult-onset growth hormone deficiency: causes, complications and treatment options

[~MaryO~]

From long URL

 

August 2008, 15:4 > Adult-onset growth hormone deficiency:...

 

Adult-onset growth hormone deficiency: causes, complications and treatment options.

 

Neuroendocrinology

Current Opinion in Endocrinology, Diabetes & Obesity. 15(4):352-358, August 2008.

Mathioudakis, Nestoras; Salvatori, Roberto (my endo!)

 

Abstract:

Purpose of review: Description of the progresses related to the complications and treatment of adult-onset growth hormone deficiency.

 

Recent findings: Growth hormone deficiency in adults has gained attention as a clinical syndrome associated with increased morbidity and possibly mortality. Many studies have been conducted on the consequences of growth hormone deficiency and of its replacement, supporting its use in appropriate patients. Early studies were characterized by a high incidence of side effects due to a lack of pilot data to guide appropriate dosing. Given the wide variability in individual responsiveness to growth hormone therapy based on age, sex, and body composition, recent work has been dedicated to understanding which patients derive benefit from therapy, minimizing side effects, and ensuring cost-effectiveness.

 

Summary: Long-term prospective trials have shown that growth hormone replacement therapy results in improvements in body composition, dyslipidemia, bone mineral density, and quality of life. The effects on endpoints such as cardiovascular morbidity and mortality and fractures are, however, not fully proven. Randomized trials that compare homogenous groups of growth hormone deficiency patients are still needed. Given the high cost of treatment, dynamic testing for growth hormone deficiency should only be performed in patients in whom there is high clinical suspicion, and therapy should be limited to those with biochemically proven growth hormone deficiency.

 

© 2008 Lippincott Williams & Wilkins, Inc.

[justashell]

I don't like the sound of that last sentence:

 

"Given the high cost of treatment, dynamic testing for growth hormone deficiency should only be performed in patients in whom there is high clinical suspicion, and therapy should be limited to those with biochemically proven growth hormone deficiency."

 

Just saying...

OK---I'm saying that people should come before money!!!

[~MaryO~]

Tell that to your insurance company!

 

For years I refused to take Premarin on moral grounds. My gyne was ok with that, I was doing fine on another med...some twit at my insurance company who had probably never been to med school told, not suggested, but TOLD my gyne that I had to be switched to Premarin because it would save the company money.

 

Fortunately, my gyne stood up for me me and I never took Premarin but that was my first reality check with the insurance bottom line.

 

Then my endo prescribed a specific brand of growth hormone but that same twit probably rejected that and said I could only take a brand that had just been ok'd for adult use.

 

It would be nice if doctors could prescribe what they learned about in med school without some insurance auditor vetoing all the doctors' choices.

[justashell]

MaryO---

 

Un-stinking-believable...I wonder if the insurance company would be liable if you suffered from blood clots or stroke due to oral estrogen?

 

There's a revolution in our town---lots of orthopedic doctors are opting out of their contracts with the insurance company. A major employer has chosen an out of state insurance company.

 

I wonder what's next...

[~MaryO~]

Interesting point. I guess I won't get blood clots now because the Premarin issue was a long time ago now. I wonder if I can blame the specific type of growth hormone I had to take because of them on my kidney cancer. hmmmmm