Page 30 - GALENIKA MEDICAL JOURNAL

treba sprovesti antropološka mjerenja (tjelesna težina, tje- hormona i kortizola i određivanje QoL pomoću adekvatnog
lesna visina, obim kuka i struka), mjerenje krvnog pritiska, upitnika. Mjerenje tjelesnog sastava i gustine kostiju meto-
lipidnog profila, insulinske senzitivnosti (glikemija našte, dom DXA, potrebno je sprovesti bazno i svakih dvije do pet
insulin, HbA1c), reproduktivne funkcije, nivoa tiroidnih godina terapije hormonom rasta .
10

Zaključak

Nedostatak hormona rasta kod odraslih osoba je sindrom koji se karakteriše nepovoljnim
fenotipskim profilom, metaboličkim poremećajima i lošim kvalitetom života. Tokom posljednje
dvije decenije, brojne studije su potvrdile poboljšanje ovih parametara na terapiji hormonom rasta
(GH). Iako je generalno bezbjedna, nadoknada GH zahtijeva pažljivo titriranje doze i praćenje u cilju
postizanja veće efikasnosti i tolerancije liječenja. I pored svih pogodnosti ovog tretmana, klinička
praksa ukazuje da je sindrom GHD često neprepoznat i da se supstitucija GH ne koristi dovoljno, iako
naš zdravstveni fond pokriva troškove liječenja. Razlog leži u nedovoljnoj informisanosti ljekara o

značaju i rizicima ove terapije, što nameće potrebu za njihovom intenzivnijom edukacijom o ranom
prepoznavanju GHD sindroma odraslih i optimizaciji liječenja.

Abstract

Growth hormone deficiency (GHD) in adults is a rare clinical syndrome with an incidence of 1.4–4.2 per 100,000 persons
per year and a prevalence of 350/million. It is characterized by unfavorable body composition, reduced muscle, and bone
mass, lower capacity to endure physical effort, abnormal lipid profile, increased cardiovascular risk and poor quality of
life. Despite these clinical manifestations, GHD is often unrecognized, so its diagnosis is often missed or delayed. The
reason is the non-specific and subtle clinical characteristics, which require the testing of growth hormone (GH) secretion
with stimulation tests. Two tests are in use, the insulin tolerance test and the glucagon test, which require the experience
of the team performing them. Recently, an oral secretagogue of growth hormone - macimorelin has been used, which
is simple test to perform and is safe for the patient. Insufficient secretion of GH in adults can be manifested as isolated
or in combination with deficits of other pituitary hormones. However, GH is the most frequently detected hormonal
deficit in adults as part of hypopituitarism. Causes of GHD can be congenital or acquired. Congenital reasons are the
result of disorders of the embryogenic development of the pituitary gland and hypothalamus, and acquired are the most
common complications of tumors of the sellar region and head trauma. Patients with GHD have an increased mortality
rate compared to the general population. The causes of the shortened life span of these patients depend on the etiology
of hypopituitarism, the applied therapy of tumors of the hypothalamus/pituitary region (surgery, radiotherapy), and the
replacement of other missing pituitary hormones. During the last two decades, growth hormone therapy in adults has
entered routine clinical practice. The beneficial effects of this substitution are reflected in the body composition, skeletal
system, metabolic status, and improvement of the quality of life. GH replacement in adults returns the mortality rate to
that expected for age in the general population. Due to the known proliferative, angiogenic, and anti-apoptotic properties
of GH, there is still some caution regarding the recurrence of hypopituitarism-causing tumors or the appearance of new
tumors during GH replacement. However, large and long-term follow-up studies of adults on GH therapy have shown a
high safety profile of this treatment. Daily injections of GH were until recently the only way of its application, and now long-
acting weekly forms have been marketed, which will significantly improve adherence to this therapy.

Keywords: growth hormone deficiency in adults, growth hormone replacement in adults, transition

28 DOI: 10.5937/Galmed2409023D