By Patricia Khashayar, MD., Press TV, Tehran

At the International Congress of pituitary lesions, held October21-23, 2009, in Tehran, Iran, emerging data were presented on the role of growth hormones in the treatment of adult patients suffering from adult growth hormone deficiency (AGHD).

We sat down with Professor Mary Lee Vance, MD, to discuss some of the data as well as the prevalence of this condition and its associated burden.

Dr. Vance is a Professor of Neurosurgery and Endocrinology at the University of Virginia Medical School and has received “The Best Doctors in America” for seven consecutive years. She has published more than 100 articles and numerous book chapters on the topic as well as other pituitary disorders.

The disorder of growth hormone, a major metabolic and anabolic hormone that regulates protein, lipid, and carbohydrate homeostasis, was one of the main topics discussed at the congress.

Press TV: While growth hormone deficiency and subsequent growth failure and short stature are well-known by pediatric population, the condition is often left un/misdiagnosed or untreated among adults. Could you tell us what adult growth hormone deficiency (AGHD) is?

Professor Vance: Adult growth hormone deficiency (AGHD) is secondary to loss of GH production as a result of hypothalamic/pituitary disease and treatment(s) such as pituitary surgery and radiation. Pituitary tumors, hence, are the most common causes of the condition. The condition, however, can be a congenital disorder in certain cases.

Press TV: What are the signs and symptoms of the condition?

Professor Vance: The condition may present with a variety of symptoms including fatigue, loss of exercise endurance, social withdrawal, and increased abdominal girth.

Growth hormone deficiency (GHD) in adults is associated with increased adipose mass particularly intra-abdominal fat, total and LDL cholesterol and carotid media intima thickness along with decreased muscle mass, bone density, and quality of life.

Press TV: In the United States, the incidence of growth hormone deficiency in children is estimated to be between 1 in 4,000 and 1 in 10,000. How prevalent is the condition among adults?

Professor Vance: The exact prevalence of the condition is not known as not everyone with a pituitary tumor is tested for GH deficiency.

Press TV: How is AGHD diagnosed?

Professor Vance: The condition is mainly diagnosed through:

(1) Stimulation test, which measures the capacity of the pituitary gland to produce growth hormone through measuring the blood levels of growth hormone (GH) during insulin hypoglycemia or after the patient receives arginine or GH-releasing hormone (GHRH).

(2) A patient with multiple pituitary hormone deficiencies and low serum IGF-1 levels for his/her age is also highly suspicious to have AGHD.

Press TV: What are the consequences of AGHD if left untreated?

Professor Vance:Abnormal body composition, reduced bone loss, hyperlipidemia, and poor quality of life are the main consequences of the condition if left untreated.

Press TV: How are the adults suffering from the condition treated?

Professor Vance: GH replacement through a single subcutaneous injection of recombinant human GH is the main treatment for AGHD sufferers. In this approach GH dose should be adjusted to achieve a normal serum IGF-1 for age, preferably in the mid-range of normal.

Press TV: Are there risks and benefits involved in the decision to treat with growth hormone and when to begin treatment in a particular patient?

Professor Vance: The treatment improves body composition (decreases fat mass, increases muscle mass and bone density without influencing the patient's weight) as well as the quality of life while reducing the use of medical resources including visits to doctors and absence from work.

Using too high doses, however, is troublesome and may place the individual at various health risks.

Press TV: Does the treatment increase the risk of developing cancer among these patients?

Professor Vance: While the use of GH is not associated with an increased cancer risk among users, GH should NOT be given to anyone with a malignancy or history of such diseases.

Press TV: What is the importance of staying on treatment for the rest of their life?

Professor Vance:Similar to other hormone replacements (thyroid hormone glucocorticoid, gonadal steroid), the drug is only beneficial as long as it is taken.

Press TV: In your experience, are there psychosocial burdens that affect treatment options or treatment adherence?

Professor Vance: No, the main limitation for prescribing and using GH in adult patients include the high cost of the drug and the fact that most patients have to pay for a portion of the cost even if they have insurance.

Press TV: And the last question, did you enjoy your trip to Iran?

Professor Vance:It was fantastic. Iran is a beautiful country with lovely people.