Synopsis
Diagnose adult growth-hormone deficiency in the right clinical context and deliver monitored specialist replacement only when benefit and safety criteria are met.
- Adult growth-hormone deficiency is most credible after pituitary or hypothalamic disease, surgery, radiotherapy, trauma, genetic disease or multiple other pituitary deficits; fatigue and central adiposity alone are not diagnostic.
- Recognised effects include impaired quality of life, reduced exercise capacity and lean mass, increased visceral fat, adverse lipids and reduced bone density, but each is nonspecific and alternative causes remain important.
- A random growth-hormone concentration cannot diagnose deficiency because normal secretion is pulsatile; IGF-1 supports the assessment but a value inside the reference range does not reliably exclude disease.
- Most adults require a supervised dynamic stimulation test chosen for comorbidity, local expertise and assay; insulin tolerance testing is hazardous in seizure or significant cardiovascular or cerebrovascular disease.
- Establish and safely replace cortisol deficiency before adjusting thyroid hormone or performing a provocative test that could precipitate hypoglycaemia or physiological stress.
- NICE TA64 restricts somatropin for adult-onset deficiency to severe biochemical disease, significant QoL-AGHDA impairment and appropriate treatment of other pituitary deficits, with a defined nine-month benefit review.
- Somatropin is titrated individually to clinical response and age-adjusted IGF-1 rather than body weight alone; oedema, arthralgia, carpal-tunnel symptoms and dysglycaemia commonly signal excessive exposure.
- Active tumour must be excluded and prior intracranial disease remains under surveillance; new severe headache or visual symptoms require reassessment rather than assuming a benign replacement adverse effect.
- Young people treated for childhood-onset deficiency need a named transition plan and usually reassessment after linear growth, while permanent structural or genetic contexts may alter how confirmation is approached.
Key red flags
Hypotension, vomiting, hypoglycaemia, hyponatraemia or reduced consciousness in pituitary disease suggests cortisol deficiency; give emergency glucocorticoid treatment before pursuing growth-hormone testing.
Severe hypoglycaemia, seizure, loss of consciousness or ischaemic symptoms during a dynamic test requires immediate protocol resuscitation and termination of the study.
New visual-field loss, ophthalmoplegia or abrupt severe headache may indicate pituitary tumour growth or apoplexy and needs urgent imaging and specialist assessment.
Evidence of active malignancy or progressive intracranial tumour precludes routine somatropin initiation and requires oncology-endocrinology review under the current product information.
Papilloedema symptoms, severe recurrent headache, visual disturbance, nausea or vomiting after replacement can indicate intracranial hypertension and warrant urgent examination and treatment interruption advice.
Somatropin in an acute critical illness following major surgery, polytrauma or respiratory failure raises a specific safety concern; the responsible endocrine and critical-care teams must review continuation.
Investigation priorities
Establish whether hypothalamic-pituitary disease is sufficiently likely to justify specialist dynamic testing.
Management branches
Symptoms occur in a person with pituitary disease, cranial treatment or another credible hypothalamic-pituitary risk.
- Confirm the anatomical and treatment history, review every pituitary axis, medicines, sleep, mood, nutrition and systemic disease, and document objective morbidity.
- Measure IGF-1 in an assay-aware context, recognising influences that can lower it and that a normal result may not exclude organic disease.
- Stabilise cortisol and other clinically important deficits before choosing a dynamic test; never provoke hypoglycaemia in an unsafe setting.
- Have an endocrinologist select and interpret the validated stimulation protocol, integrating the result with pre-test probability rather than labelling symptoms alone.