The clinical syndrome of adult growth hormone deficiency (AGHD) was widely recognized in the 1980s. In this review, we first describe the clinical features and diagnosis of AGHD and then state the effects of growth hormone (GH) therapy for these patients. The main characteristics of AGHD are abnormal body composition, dyslipidemia, insulin resistance, and an impaired quality of life (QoL) due to decreased psychological well-being. For diagnosing AGHD, the international consensus guidelines have suggested that an insulin tolerance test (ITT) is the gold standard, but in Japan, the growth hormone releasing peptide-2 (GHRP-2) test is available and is recommended as a convenient and safe GH stimulating test. The cut-off for diagnosing severe AGHD is a peak GH concentration of 9 g/L during the GHRP-2 test. Since 2006, GH therapy has been approved for Japanese patients with severe AGHD. For adults, GH replacement therapy should be initiated at a low dose (3 g/kg body weight/day), followed by individualized dose titration while monitoring patients' clinical status and serum insulin-like growth factor-I (IGF-I) concentrations. A variety of favorable effects of GH replacement have been indicated; however, it has not yet been established fully whether there is a direct effect of GH treatment on reducing mortality.
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机译:成人生长激素缺乏症(AGHD)的临床综合征在1980年代得到广泛认可。在这篇综述中,我们首先描述AGHD的临床特征和诊断,然后陈述生长激素(GH)治疗对这些患者的影响。 AGHD的主要特征是身体成分异常,血脂异常,胰岛素抵抗以及由于心理健康状况下降而导致的生活质量(QoL)下降。对于AGHD的诊断,国际共识指南建议以胰岛素耐受性测试(ITT)为金标准,但是在日本,可以使用生长激素释放肽2(GHRP-2)测试,建议将其作为一种方便且安全的方法GH刺激试验。诊断严重AGHD的临界值是GHRP-2测试期间GH峰值浓度为9 g / L。自2006年以来,GH治疗已被批准用于日本重度AGHD患者。对于成人,GH替代疗法应以低剂量(3 g / kg体重/天)开始,然后进行个体化剂量滴定,同时监测患者的临床状况和血清胰岛素样生长因子-I(IGF-I)浓度。已经表明了GH替代的多种有利作用;然而,尚未完全确定GH治疗是否对降低死亡率具有直接作用。
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