Management of Somatotropin Deficiency in Adults

Management of Somatotropin Deficiency in Adults - Flowchart Hypopituitarism Hypopituitarism

«Flowchart»

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Pituitary pathology clinical features of hyposomatotropism evoked GH <3 µg/L IGF1 low (not invariable)

Pituitary pathology clinical features of hyposomatotropism evoked GH <3 µg/L IGF1 low (not invariable) Pituitary pathology clinical features of hyposomatotropism evoked GH <3 µg/L IGF1 low (not invariable)

Assess unique dose requirements: Women on estrogen; elderly patients

Initiate GH replacement 0.15-0.3 mg/day

Exclude contraindications for GH replacement

No active tumor
No retinopathy
Diabetes controlled

Exclude contraindications for GH replacement

No active tumor
No retinopathy
Diabetes controlled

Exclude contraindications for GH replacement

No active tumor
No retinopathy
Diabetes controlled

No active tumor No active tumor
No retinopathy No retinopathy
Diabetes controlled Diabetes controlled

Measure IGF1 levels after 1 mo

1 mo

Continue treatment monitor IGF1, lipids, bone density

Discontinue Rx

Titrate GH dose to normalize IGF1 levels, based on age- and gender-matched controls, or until symptom tolerance

No clinical response after 6 mo

Clinical response

End