Growth Hormone Deficiency
Adult growth hormone deficiency is diagnosed and treated per the Endocrine Society Clinical Practice Guidelines (2011) on diagnosis and 2016 guideline on treatment.
Symptoms
Reduced energy and quality of life, increased body fat (especially abdominal), reduced muscle mass, and unfavorable changes in cholesterol -- nonspecific enough that it's often identified in people with a known pituitary condition rather than from symptoms alone.
Causes and risk
Pituitary tumors, prior pituitary surgery or radiation, traumatic brain injury, and childhood-onset GH deficiency continuing into adulthood are the main causes.
How it is evaluated
Stimulation testing (the insulin tolerance test is the reference standard, with GHRH-arginine or glucagon as alternatives) confirms the diagnosis; having three or more other pituitary hormone deficiencies is accepted as a diagnostic shortcut without stimulation testing.
Treatment
Recombinant growth hormone replacement, started at an age-stratified dose and titrated to IGF-1 levels, per current FDA labeling and Endocrine Society guidance.
When to seek care
GH deficiency itself is not an emergency. Adrenal crisis and pituitary apoplexy -- true emergencies in people with pituitary disease -- are what to watch for instead.