To establish the diagnosis in patients without these criteria requires provocative growth hormone stimulation. Adults diagnosed in childhood with isolated growth hormone deficiency often have normal growth hormone secretion after puberty and need retesting before continuing replacement therapy into adulthood. The ?gold standard,? an insulin tolerance test, is time consuming, expensive, and potentially dangerous. The next best test combines stimulation with arginine and GHRH. Stimulation with arginine or L-Dopa alone or serum IGF-1 concentrations alone are not considered adequate to establish the diagnosis.

Treating a patient with recombinant human growth hormone is expensive and has significant side-effects including edema, arthralgias, carpal tunnel syndrome and glucose intolerance. Most of the symptoms of adult growth hormone deficiency can be treated successfully with weight loss and medications directed at specific abnormalities such as hyperlipidemia and decreased bone mineral density. Treatment with recombinant human growth hormone should be considered only in adults with well established growth hormone deficiency.

About AllMed Healthcare Management

Founded in 1995, AllMed is a URAC-accredited Independent Review Organization (IRO) serving insurance payers, providers, TPAs and claims managers nationwide.
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