Adult growth hormone deficiency: to treat or not to treat.

In the last 15 years, it has been recognised that growth hormone deficiency (GHD) in the adult leads to increased morbidity (metabolic syndrome, osteoporosis, muscle wasting, impaired quality of life) and increased incidence of cardiovascular events, a main cause of the increased mortality observed in this population. Pituitary adenomas and their treatment (surgery, radiation) are the most common cause of GHD in adults. Patients with biochemical diagnosis of severe GHD must be offered growth hormone replacement therapy only in the presence of GHD associated morbidity. This treatment improves morbidity, but its effect on mortality remains to be proven. Continuation of treatment for GHD patients in late adolescence to early adulthood, who have reached final height with growth hormone replacement, requires careful clinical judgement.