Adult Growth Hormone Deficiency : A Practical Approach to Diagnosis and Treatment for Neurosurgeons

Abstract

  Patients with adult growth hormone deficiency (AGHD) present with diverse clinical symptoms associated with impaired quality of life and an approximate 2-fold increase in mortality, as compared with the general population. As most acquired causes of AGHD are associated with neurosurgical disorders (e. g., hypothalamic and pituitary tumors, pituitary surgery, and cranial radiotherapy), an accurate diagnosis of severe AGHD in daily neurosurgical practice followed by hormone replacement therapy with daily or weekly recombinant human growth hormone (rhGH) injections is critical. To achieve this aim, AGHD should be suspected in patients with current or a history of intracranial disease, and a diagnosis of severe AGHD should be established with growth hormone (GH) stimulation testing. As patients who are diagnosed with AGHD after cranial surgery or radiotherapy may not be granted medical expense support for a designated intractable disease, preoperative GH stimulation testing is crucial to prove that the patient had AGHD before surgery or radiotherapy. For patients who have undergone surgery for craniopharyngioma or pituitary adenoma, outpatient follow-up (every 3-6 months) is recommended to monitor the GH secretion status. Understanding the characteristics of rhGH injections, including common adverse events, contraindications, and the need for dose titration, is crucial, and neurosurgeons should inform patients about the potential risks of tumor recurrence. Consensus among neurosurgeons for the treatment of AGHD is warranted, as are guidelines for collaboration among different specialties.