Kathryn Jean Lucas, MD
611 N 35th St
Morehead City, North Carolina 28557

inside health

Evaluation Process of Adults with Growth Hormone Deficiencies

Introduction

You have been referred to an endocrinologist, a doctor who specializes in the diagnosis and treatment of disorders of the endocrine glands. Endocrine glands release chemicals into the blood which tell parts of the body to do certain jobs. These chemicals are referred to as hormones. Endocrine disorders are those that involve deficiencies or excesses of hormones. A deficiency exists when there is not enough of a hormone in the body. In order for your doctor to make an accurate diagnosis, some testing may be necessary. This pamphlet was written to help you and your family understand the evaluation process of hormone deficiencies.

Control of Hormones/Hormone Deficiency

The hypothalamus controls the pituitary gland; both are located in the brain. The pituitary gland releases or controls many hormones in the body. The hormones are released in very small amounts into the bloodstream and then travel to parts of the body (referred to as target organs) to perform a specific job. These hormones control many of the body’s functions, which are the following: Thyroid Stimulating Hormone (TSH) turns the thyroid gland "on" in order to control your metabolism. Adrenocorticotrophic hormone (ACTH) stimulates cortisol production to assist your body in daily function and stress. Vasopressin assists in the salt and water regulation of the body. Gonadotropins (FSH, LH) stimulate the ovaries (in women) or testes (in men) to release "sex" hormones (estradial or testosterone). Growth Hormone is released from the pituitary gland to cause growth in children and affects bone density, lipid metabolism, and muscle in children and adults.

Deficiencies of these hormones may occur alone or in combination with one or more other hormone deficiencies. The hormone(s) deficiency may be congenital, resulting from a defect in the brain. The deficiency may also be acquired, stemming from the damage to the brain after a sever head injury, serious illness (such as meningitis or encephalitis), brain tumor and/or radiation. Sometimes no cause for the hormone deficiency can be identified.

Evaluation/Testing

In order to confirm or determine the possibility of hormone deficiencies your doctor will perform an examination and ask you some questions. Past records may have to be reviewed. Screening blood tests will usually be done. These blood tests will check the secretion of the pituitary hormones and their target organs. Possible tests that may be done are listed:

T4/TSH (to test thyroid function)

Cortisol

FHS/LH (to test stimulation ability of the ovaries/testes)

IGF-1 (an indirect measure of growth hormone)

Electrolytes (measures water & salt balance)

You may need to have a picture of the brain; this is done by a CT Scan or MRI. A CT scan gives a detailed picture of the brain using x-rays and a computer. A MRI gives a detailed picture of the brain using a magnet, radio waves and a computer. These tests are not painful but you will have to hold still for approximately one hour during the test.

Growth Hormone

If there is a possibility that you have growth hormone deficiency more testing will have to be performed. Growth hormone is secreted by the pituitary gland in quick bursts and does not last long in the blood, so checking a single blood sample for growth hormone will not be helpful. Deep sleep, vigorous exercise, and certain drugs are known to stimulate the secretion of growth hormone. The amount of growth hormone in the blood is measured by taking blood samples over a period of time. This is done by performing a "stimulation test." This refers to drawing baseline hormone levels, stimulating growth hormone release by giving a drug, and drawing intermittent growth hormone levels for one to three hours. The specifics of the tests, such as type of drug, length of test, and amount of the samples, will be determined by your doctor.

The doctor will need to make sure you are on adequate hormone replacement for other hormone deficiencies prior to stimulation testing. You will be given instructions. You should not have anything to eat or drink, except for water, after midnight the night before the test. You should have minimal activity before the test (no exercise that morning). An indwelling venous line (IV) will be started and baseline hormone levels drawn. You will be given a medication. The medication and its effects will be reviewed by your doctor or nurse. Growth hormone levels will be drawn intermittently from the IV at specified times for a period of two hours. If the IV stops working during the test, it is important that it be restarted so the samples may be obtained at the specified times.

The purpose of the testing is to determine if you are growth hormone deficient and/or eligible for growth hormone therapy. In order to start growth hormone treatment you will have one to two simulation tests performed. The number of tests will be decided by your doctor. Adults with peak growth hormone levels less than 3-5 mcg/L are identified as Growth Hormone Deficient. Please keep in mind that these numbers are not definitive; your doctor will make the final diagnosis. It may take several weeks for your doctor to receive and review the test results. You should discuss the results and the possibility of growth hormone therapy with your doctor.

Summary

Hormone replacement will be prescribed by your doctor if you are deficient in pituitary hormones. Remember, each hormone has a specific function in your body, replacement medication is very important. If you have any questions don’t hesitate to call your doctor, nurse, or the MAGIC Foundation for resources.

Contributing Medical Specialist

Colleen Weber, R.N., B.S.N. Cardinal Glennon Children’s Hospital St. Louis, Missouri

Adults Who Live with Growth Hormone Deficiency
(GHD)
(GHD)

GHD can affect your life quality

If you are diagnosed with GHD because of low or absent growth hormone (GH) secretion levels you may experience a number of different physical and emotional symptoms. Feeling tired, listless, easily fatigued, and having a lack of motivation are often reported by patients. Some individuals also report feeling anxious, irritable, losing interest in sex, and a pervasive sense of gloom and pessimism about their lives. Because of these effects, persons with GHD may tend to avoid contact with others, show signs of stress in their marriage, and experience a gradual decrease in their productivity at work. Quality of life begins to decline and the affected individual often suffers in silence. This brochure is provided to help you understand these feelings and what actions you can take to improve your life.

How GH can cause moods and emotions to change

Although we refer to it as "growth" hormone, GH actually has many other functions than helping growth to occur. GH is a powerful brain hormone that is believed to play an important role in stimulating and controlling areas of the brain that regulate moods and emotions. Certain chemicals in the brain, called neurotransmitters are dependent on the effects of GH to help them carry their messages between brain centers. If GH is not available, these functions may not occur appropriately and the result can be uncontrolled changes in psychological functioning. Individuals may feel anxious, depressed or worried for no apparent reason when this happens, and this may cause changes in behavior or decline in social functioning. Negative and sad feeling may dominate your mood, and positive or joyful feelings can be dampened. An affected individual could feel unable to enjoy life and lack the motivation to make change in their circumstance. It is important to remember that these emotional changes are not usually directly related to actual life events and therefore are difficult to anticipate. Research has shown that many GHD patients suffer these symptoms privately and do not report them to their doctors. This is unfortunate because there are several treatments available to help manage these problems.

GHD in childhood versus adulthood

Children who are GHD often grow up with problems related to being small, feeling unhappy with their self-image, having few friends, and, perhaps also not doing well in school. Many short children are bullied and called cruel nicknames such as "shorty" or "shrimp" which are very painful. These difficulties can have a powerful effect on self-esteem and social skills, and if these effects are carried into adulthood quality of life may be more complex and therefore difficult to change. In contrast, adults who develop GHD later in life may be surprised by their emotional changes and psychological symptoms, but because of their previous life experience and maturity, they are better prepared to find a solution. In either case, consultation with your doctor can lead to appropriate treatment options.

The special problems of short stature

Short stature in childhood may be corrected by GH treatment, but above average height is not achieved in all patients. Feeling "short" and therefore different from others may lead to secondary adjustment problems which can compound the biological effects of GHD mentioned earlier. If a poor self-image develops, lowered self-esteem, anxiety, pessimism or even depression may arise. Common signs of this are: feeling isolated from others, "left out" or shunned, becoming sarcastic or cynical, being overly sensitive to criticism, or lacking ambition and drive. No one has all these symptoms at the same time, but any one of them or a combination of such symptoms indicate you should seek help, either from a counselor or your doctor.

What can be done to help you

You should feel entirely comfortable speaking with your doctor about any problems you have regarding your feelings or emotions. In some instances it may be that GH replacement treatment will make a significant difference in your sense of well-being, and nothing further is needed. In others, medication to control anxiety or depression can be beneficial. Certain forms of counseling also alter anxiety and depression by modifying negative and dysfunctional beliefs and thought patterns. This is called cognitive-behavior and is usually carried out by a specially trained psychologist. All these options can be discussed with your doctor who will help you make the best decisions.

Support groups

Many people who have chronic medical conditions find it helpful and rewarding to meet regularly in a group setting with others who have similar problems. These self-help groups are effective for patients with conditions such as diabetes, cancer, and arthritis. In a safe and supportive group you can learn to understand, accept, and manage your condition through mutual support, information-sharing, and problem solving based on the experiences of others.

Sources of information about psychological counseling

Two major professional groups provide a toll-free number through which you can get the names of counselors and doctors specializing in areas which can be helpful to you.

American Psychological Association
800-259-2666

American Psychiatric Association
800-366-8455