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Brief and Straightforward Guide on: Growth Hormone Deficiency In Adults

The Patho-physiology of Growth Hormone deficiency in Adults

The Human Growth Hormone (HGH) is a complex protein molecule that is synthesized in the Pituitary gland located at the skull base. The Pituitary gland produces and secretes the Growth Hormone (GH) directly in to the blood stream. The GH in the blood stream attaches itself to specific binding proteins in various tissues and organs, and promotes reproduction and multiplication of the organ cells. Reduced secretion of the Growth Hormone in children is associated with stunted growth and short stature. Similarly, deficiency of HGH tends to affect adults in several ways. FDA has approved the use of HGH in adults suffering from Growth Hormone Deficiency.

Causes of Adult Growth Hormone Deficiency

The causes of Growth Hormone deficiency in adults is invariably related to some form of damage to the Pituitary, and could be caused to due to the following reasons:

• Tumors of the Pituitary gland can result in Growth Hormone deficiency in adults.
• Irradiation to the Pituitary gland, as a therapy for the management of Pituitary cancers can also be one of the causes of Pituitary damage and GH deficiency.
• Trauma or surgery of the Pituitary can also result in GH deficiency in adults
• Some endocrinologists believe that an inflammation of the Pituitary gland is also one of the rare causes of deficiency of the Growth Hormone.

Clinical Manifestations of Growth Hormone Deficiency in Adults

The clinical manifestations of GH deficiency syndrome in adults has three components:

• Change in Body Composition: the Growth Hormone is responsible for maintaining a balance between the adipose tissue mass and the muscle mass. The reduced production of this master hormone would result in reduced lean muscle mass, and accumulation of fat. The reduction in muscle mass also results in poor muscle performance and reduced exercise capacity. On the other hand, fat deposition takes place beneath the skin, especially, around the waist (called as visceral fat). As per medical studies, increased visceral fat has been found to be associated with atherosclerosis and development of other disorders like diabetes.

• Change in the blood profile: HGH also regulates the cholesterol levels in the blood. The reduced production of the hormone has been linked to changes in the composition of the cholesterol profile, which results in an increase in the Low Density Lipoproteins (LDL) i.e. the ‘bad’ cholesterol, whilst, there occurs, a concurrent decrease in the High Density Lipoproteins (HDL) i.e. the ‘good’ cholesterol. The fall in HGH also raises the levels of blood triglycerides, which causes premature aging of the blood vessels and consequently, atherosclerosis.

• Psychological Changes: Extensive clinical research and documentation has pointed out the potential impact of lower levels of HGH on the psychological stability of individuals. There occurs a loss of interest in the usual hobbies and activities, loathing, indifference, social isolation from friends and family, mood swings, depression and decreased sexual desire and reduced libido.

Diagnosing Adult Growth Hormone Deficiency

The levels of the Growth Hormone vary considerably. As the age advances, the secretion of Growth Hormone drops at the rate of 14 % every decade. Further, in the same individual, the levels vary during the day, as the hormone is released in spurts. The highest levels of GH secretion occur, about an hour after a person falls into deep sleep. This tendency of the level of the Growth Hormone to vary, makes it very difficult to detect it, even among normal individuals. Hence, a random blood test can’t be taken as conclusive evidence of Growth Hormone deficiency.

One of the ways of testing the Growth Hormone levels is the ‘GH stimulation tests’. The basic philosophy is, to stimulate the gland to release Growth Hormone. This test is conducted on an out-patient basis, and could take about three to four hours. The patient is requested to provide a sample of their blood, without eating. Following this, the patient is requested to eat something (i.e. after stimulation) and a repeat blood sample has to be provided. This helps the physician to assess the highest and lowest levels of GH in the blood. Alternatively, the physician could take multiple blood samples at different times of the day, on different days, to determine the highest and lowest GH levels. Based on this, the physician will evaluate whether the patient suffers from a GH deficiency or not.

Treatment of Adult Growth Hormone Deficiency

The most commonly preferred and effective treatment is GH replacement therapy, which involves the use of synthetically prepared recombinant Growth Hormone. The treatment is initiated with an initial small dose of the hormone, and is gradually raised till a maintenance dose is achieved. The treatment involves taking GH injections every day.

The procedure for administering the injections is similar to that of taking Insulin, and can be self-administered after a few initial injections by the prescribing doctor. The physician follows up with the patient at an interval of six to eight weeks. The patient is asked to undergo blood tests to ascertain the correct dose. The test is commonly referred to as Insulin-like growth factor test (IGF-1 test). The test measures the value of IGF-1, which is an indication of the level of requirement of the Growth Hormone. The lower the levels of IGF-1, the higher GH dose is required. Similarly, higher IGF-1 levels are an indication to reduce the dose which is being prescribed. Based on this assessment, a final dose is established and maintained. Once the final dose is ascertained, the frequency of follow ups and blood tests are reduced to once every four to six months.

As an alternative technique, for patients with a Pituitary tumor, the physician monitors GH therapy using MRI. Also, some physicians chose to monitor the patient by regularly evaluating their bone density and blood cholesterol level.

The FDA has approved the use of the Growth Hormone replacement therapy for adult patients suffering from GH deficiency. The use of HGH therapy is associated with complications like joint pain, fluid retention in the body and carpel tunnel syndrome. However, GH replacement therapy for patients who are deficient in GH, is a lifelong treatment and has been found to be successful in most cases.