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Last week the American Association of Clinical Endocrinologists released their revised guidelines for treatment of growth hormone deficiency. This revised document greatly updates the organization’s position on the use of Human Growth Hormone (hGH) and provides guidance for uses outside the traditional scope of rare metabolic diseases.

We’ve written about hGH before, and the recognition of hGH deficiency in patients that are outside the realm of strange endocrine tumors is a big step forward. Sadly, these guys aren’t the most compelling or bounciest writers. From time to time we have to cover the very dry scientific literature, this is one of those times. Let’s take a look at what the endocrinologists had to say.First of all, the new guidelines offer algorithms for diagnosing hGH deficiency. This is new to the current version of the document and hugely important. They now recognize a history of head or brain injury as a reason to screen for hGH deficiency, a big deal. It has been known for some time that head injuries can damage the pituitary gland’s ability to secrete hGH but there has been little authoritative guidance to justify screening for hGH deficiency in these patients or even justifying the diagnosis of hGH deficiency.

While specifically warning against the use of hGH for sports performance enhancement and anti-aging, the justification for screening those patients exists. The number of athletes with histories of concussion injuries to the brain is significant and those patients can justifiably be screened. A fair number of those will qualify for treatment under the new guidelines. The same is true of aging patients. The guidelines note that “The severity of traumatic brain injury and aneurysmal subarach- noid hemorrhage does correlate well with the degree of the pituitary dysfunction,” meaning that even seemingly minor injuries to the brain can result in hGH deficiency.

What remains interesting is that the association still relies on complicated and dangerous testing to confirm the diagnosis. The anti-aging experts are relying on the screening tool of monitoring Insulin-Like Growth Factor 1 (IGF-1) as it moves in parallel to the difficult to measure hGH. Instead the endocrinologists insist that Insulin Tolerance Testing (ITT) be used even though “is not without inherent danger of causing a seizure or unconsciousness.” To me this sounds like a bad idea, particularly when IGF-1 correlates well with hGH levels. It’s probably overkill to use this kind of testing unless clinically someone is looking to avoid a major scandal while treating a professional athlete with hGH.

The endocrinologists do finally acknowledge that adult hGH deficiency is a really bad thing and everything from cardiovascular events and osteoporosis to metabolic consequences can be attributed to hGH deficiency. They also acknowledge that “Reductions in physical and mental energy, dissatisfaction with body image, and poor memory have been reported” by patients with hGH deficiency. No suprise that hGH deficiency makes patients feel like crap. We’ve know that for while, which is why hGH has gotten so much anti-aging attention.

What’s really changed?

For doctors doing hGH therapy in their clinics, only a little. Those docs doing hGH supplementation have already looked at the law and the clinical data to support their prescribing. The endocrinologists are taking baby steps forward on not just expanding their diagnoses of hGH deficiency but are also finally acknowledging that deficiency exists places we haven’t traditionally been looking.

How to reach the diagnosis of hGH deficiency is still somewhat controversial. The endocrinologists continue to insist that complicated and dangerous testing must be done to confirm low hGH in patients while other specialties from sports medicine to anti-aging are just following the more easily measured IGF-1. Neither approach is wrong, one is clearly more practical.

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