Growth Hormone Deficiency Clinical Practice Guidelines (AACE/ACE, 2019)

American Association of Clinical Endocrinologists (AACE) and American College of Endocrinology (ACE)

This is a quick summary of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

January 31, 2020

Guidelines for the management of growth hormone deficiency in adults and patients transitioning from pediatric to adult care were published in 2019 by the American Association of Clinical Endocrinologists (AACE) and American College of Endocrinology (ACE).[1]

Consider the possibility of adult growth hormone deficiency (GHD) in patients with a history of hypothalamic-pituitary disease.

It is important to recognize the differences in the etiology of childhood-onset growth hormone deficiency (CO-GHD) versus adult-onset growth hormone deficiency (AO-GHD). Since CO-GHD occurs during the developmental years adults with this condition may have been GH-deficient for a longer time than patients with AO-GHD.

GH–stimulation testing should be performed to confirm diagnosis, as random serum GH and IGF-1 levels cannot be used alone to diagnosis adult GHD.

Use the insulin tolerance test (ITT) to establish a diagnosis of GHD. If this test is contraindicated, use the glucagon stimulation test or macimorelin stimulation test instead.

Perform 1 GH-stimulation test to confirm the diagnosis in patients with ≤2 pituitary hormone deficiencies (PHD), as low-serum IGF-1 levels alone are not sufficient to make a diagnosis of adult GHD.

Use Body Mass Index–appropriate GH cut-points to diagnose adult GHD. Use the GH cut-point of 3 μg/L for normal-weight (BMI <25 kg/m2) and overweight (BMI 25 to 30 kg/m2) patients with a high pretest probability, and a lower GH cut-point of 1 μg/L for obese (BMI >30 kg/m2) and overweight (BMI 25 to 30 kg/m2) patients with a low pretest probability.

Closely monitor adults with CO-GHD caused by structural pituitary or brain tumors during their transition to adult-care services. These patients tend to have lower bone mineral density, impaired bone microarchitecture, and more adverse body composition abnormalities and cardiovascular risk markers than patients with AO-GHD.

Recombinant human growth hormone (rhGH) replacement therapy should be individualized and initiated at low dosages.

After starting rhGH therapy, follow patients at 1- to 2-month intervals, increasing the rhGH dose in increments of 0.1 to 0.2 mg/day.

Never use rhGH replacement therapy for age-related conditions or to enhance athletic performance.

For more Clinical Practice Guidelines, go to Guidelines.

For more information, go to Hyposomatotropism (Growth Hormone Deficiency).

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