Understanding Growth Hormone Disorders: Insights into GH Excess and Deficiency

Growth hormone (GH) plays a crucial role in regulating various bodily functions, and its imbalance can lead to significant health issues. In cases where patients exhibit GH excess, particularly in conditions like acromegaly, monitoring and treatment are essential. If patients exhibit normalized levels of Insulin-like Growth Factor 1 (IGF-I) after somatostatin analogue therapy, there may be a case for withdrawing treatment. However, the relationship between GH and bowel tumor formation remains a topic of ongoing debate. Regular colonoscopy is recommended at the time of diagnosis to check for colonic polyps, which can have malignant potential.

On the flip side, GH deficiency presents differently across the lifespan. In children, it often manifests as growth failure, leading to concerns about falling off height centile charts. This condition can necessitate the attention of a pediatric endocrinologist. For adults, GH deficiency tends to develop more insidiously and is frequently accompanied by other hormonal deficiencies resulting from pituitary dysfunction.

Treatment options for acromegaly range from surgical interventions to medical therapies. Transsphenoidal surgery is typically the first-line approach, providing rapid results. However, it is invasive and requires general anesthesia, with potential risks such as inducing hypopituitarism due to damage to surrounding pituitary tissues. Alternatively, somatostatin analogues serve as non-invasive options that can lower GH levels and may even shrink large tumors, though they come with gastrointestinal side effects and significant cost implications.

Radiotherapy is considered a second or third line of defense for treating GH excess. While it is non-invasive and can effectively reduce GH levels over time, its effects are slow, often taking up to ten years to manifest fully. Additionally, this treatment poses risks for hypothyroidism and may increase the likelihood of cerebrovascular disease, necessitating careful consideration before proceeding.

A notable case highlights the importance of awareness regarding GH disorders. A 40-year-old woman, upon visiting a new doctor, was surprised by inquiries about her shoe size and facial appearance, which had changed over the years. This example underscores the subtle but impactful nature of GH excess, as physical changes can be a significant indicator of underlying hormonal imbalances.

In summary, both GH excess and deficiency require nuanced understanding and careful management. Regular monitoring, appropriate diagnostic assessments like colonoscopy, and a range of treatment options are vital in addressing the complexities associated with these hormonal disorders.