Medical Guidelines for Clinical Practice for Growth Hormone Use in Growth Hormone-deficient Adults and Transition Patients – 2009 Update

Growth-hormone deficiency (GHD) in adulthood associated with hypothalamic-pituitary dysfunction is now widely accepted as a distinct clinical syndrome, and is linked to a substantial number of metabolic abnormalities, many of which can be ameliorated with GH replacement therapy. However, despite the growing body of evidence on the benefits of GH therapy, there is still considerable variability in the United States in the clinical practice of GH replacement for adults with GHD. This variability is multifactorial, partly due to the high cost of GH therapy (GH costs approximately $50 for 1 mg of GH, or $9,125 per year for a patient on an average GH dose of 0.5 mg/day), the need for daily injections, the lack of awareness regarding its indications, diagnosis, and long-term surveillance, and concerns about whether there are long-term risks involved. In addition, there is sometimes misunderstanding regarding the difference between true GHD (ie, lower GH secretion than normal for the appropriate age and sex) versus its unapproved use in nonmedical conditions such as sports and aging.