Growth Hormone for Adults

Nearly 40 years ago it was shown that human pituitary growth hormone (but not bovine or ovine hormone) was a potent protein anabolic agent in normal adults, with a useful fat-mobilizing action in additionl. But, because of the considerable difficulty in obtaining the human hormone, research and clinical use was entirely concentrated on its major effect, growth promotion in growth-hormonedeficient children. In 1987 the first biosynthetic human growth hormone was reported equally effective in children, and the therapeutic indications were gradually widened in children of short stature. There is often a seminal observation which initiates a new aspect of clinical investigation, and one such was Preece's report on cross-sectional scans of the thigh of a hypopituitary patient who had been treated for 10 years with human growth hormone and had then stopped the daily injections for 1 year at age 18; the loss of muscle bulk and increase of subcutaneous fat was very striking2 (Figure 1). Soon after this we began to see the results of careful randomized clinical trials of recombinant human growth treatment of growth-hormone-deficient adults3-, all confirming the initial visual impression. The clinical pattern of growth hormone deficiency in adults is now becoming clear78. It includes subnormal psychological wellbeing, low vitality and social isolation, although these may be difficult to identify without complete questionnaires. The physical signs include increased body fat and waist-hip ratio, and reduction in lean body mass and muscle bulk with low muscle strength and exercise performance. Laboratory features include subnormal extracellular fluid volume, bone mineral density, glomerular