"Evaluation of Adult Growth Hormone Deficiency: Current and Future Perspectives"
Physiological growth hormone (GH) secretion is pulsatile, and pulsatile secretion accounts for > 85% of total daily GH secretion. Due to its pulsatile secretion, serum GH levels vary between peaks and troughs. In addition, GH secretion is influenced by factors such as nutrition, sleep patterns, and physical activity. Peripheral GH actions are primarily mediated through IGF-I synthesized in the liver. Insulin-like growth factor-I (IGF-I) has a longer half-life in the circulation than GH and is considered to provide an integrated measure of GH secretion. However, serum IGF-I levels frequently overlap in adults with GH deficiency (GHD) and normal subjects. Furthermore, serum IGF-I levels decline with normal aging, and tend to be low in obesity and in patients with non-alcoholic fatty liver disease. For these reasons, a diagnosis of adult GHD cannot be established by a single random measurement of serum GH or IGF-I level, but is dependent on the demonstration of a subnormal rise in peak serum GH level in response to one or more dynamic stimulation tests.
Kevin CJ Yuen, MD, FRCP (UK)
Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine, Oregon Health and Science University, Portland, OR 97239-3098, firstname.lastname@example.org
Lindsay E. Chong, MD
Division of Endocrinology, Clinical Fellowship, Oregon Health and Science University, Portland, OR 97239, email@example.com
Sharon A. Rhoads, RN, BSN
Division of Endocrinology, Endocrine Testing Unit Coordinator, Oregon Health and Science University, Portland, OR 97239, firstname.lastname@example.org
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