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Cited by 12Growth Hormone and Insulin-like Growth FactorsPituitary Gland Disorders and TreatmentsHormonal and reproductive studies

Treatment of the adult growth hormone deficiency syndrome with growth hormone: What are the implications for other hormone replacement therapies for hypopituitarism

Fierro, Gustavo, Hoffman, Andrew R.·2020·Growth Hormone & IGF Research
DOI 10.1016/j.ghir.2020.101316
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Abstract

When initiating growth hormone replacement therapy, it is important to consider a patient's other pituitary hormone replacement medications, as adjustments are often necessary. Growth hormone therapy can increase the metabolism of hydrocortisone or endogenous cortisol, unmasking borderline ACTH deficiency and leading to the development of adrenal insufficiency and adrenal crisis. In addition, growth hormone can enhance the metabolism of thyroxine to triiodothyronine, uncovering borderline TSH deficiency. In many patients, thyroid hormone replacement therapy must be started, or the dose of levothyroxine must be increased. Oral estrogen replacement therapy leads to a state of relative growth hormone resistance, and the dose of GH may need to be increased substantially. Physicians have long been cognizant of the fact that adding a new prescription medication may lead to important drug-drug interactions. Starting growth hormone therapy may lead to hormone-hormone interactions that can pose serious complications for the hypopituitary patient unless the interaction of growth hormone on other pituitary hormone systems is understood.

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  • Through acceleration of both thyroid hormone and cortisol metabolism, initiation of growth hormone replacement may unmask central hypothyroidism and hypoadrenalism; patients already under L-T4 replacement need increased L-T4 doses.

    “Through acceleration of both thyroid hormone and cortisol metabolism, initiation of growth hormone (GH) replacement may unmask CH and hypoadrenalism (82–84). Also, patients already under L-T4 replacement need increased L-T4 doses (82, 84).”

    From L-T4 therapy in the presence of pharmacological interferents (2020) · cites this paper as [83]

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Authors
Fierro, G., & Hoffman, A. R.
Affiliations
  • Universidad San Francisco de Quito (EC)
  • VA Palo Alto Health Care System (US)
Corresponding author
Hoffman, Andrew R.
ORCID
Hoffman, Andrew R.
Venue
Growth Hormone & IGF Research
Publisher
Elsevier BV
Published
2020-06
Volume
52
Pages
101316
ISSN
1096-6374 (ISSN-L)
DOI
10.1016/j.ghir.2020.101316
OpenAlex
W3013539345
Cited by
12
References
26
Citations by year
2024: 1 · 2023: 2 · 2022: 4 · 2021: 2 · 2020: 3
FWCI
2.07
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Growth Hormone & IGF Research (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Growth Hormone and Insulin-like Growth Factors
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
Keywords
adult growth hormone deficiency, growth hormone replacement therapy, hypopituitarism, drug-drug interactions, cortisol, ACTH deficiency, adrenal insufficiency, adrenal crisis, thyroxine to triiodothyronine conversion, TSH deficiency, thyroid hormone replacement, levothyroxine, estrogen replacement therapy, growth hormone resistance
MeSH terms
Adult, Dwarfism, Pituitary, Humans, Hypopituitarism, Prognosis, Human Growth Hormone, Hormone Replacement Therapy

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