Growth Hormone (GH) is licensed (and funded) in many countries for replacement therapy in adult GH deficiency, usually subjects with hypopituitarism. The accent is on "replacement" and we have advocated the use of age-standardised IGF-I reference ranges (Endocrinology & Metabolism; 1997; 4: 129-34) in guiding replacement, ideally aiming for + or - 1SD from the age-related mean. There is no evidence for benefit of treatment over and above these limits, despite the fact that GH has been touted as the veritable elixir of life. On the contrary, elevated IGF-I has been associated with increased risk of breast and prostate carcinoma, although the relevant publications, as we pointed out, did not use age-standardised IGF-I ranges (Lancet 1998: 352; 489-90). Some athletes abuse GH and the evidence, crudely speaking is that it confers bigger but not necessarily stronger muscles. Notwithsatnding all of the above, my plug in this area from a clinical chemistry perspective is for the value of age-standardised reference ranges for IGF-I in guiding GH replacement in appropriate cases.
Dr Chris Florkowski
Chemical Pathologist / Senior Endocrine Research Fellow
Christchurch Hospital, New Zealand
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