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Treatment of the adult growth hormone deficiency syndrome with growth hormone: What are the implications for other hormone replacement therapies for hypopituitarism?
Growth Hormone and IGF Research ( IF 1.6 ) Pub Date : 2020-03-23 , DOI: 10.1016/j.ghir.2020.101316
Gustavo Fierro 1 , Andrew R Hoffman 2
Affiliation  

When initiating growth hormone replacement therapy, it is important to consider a patient's other pituitary hormone replacement medications, as adjustments are often necessary. Growth hormone therapy can increase the metabolism of hydrocortisone or endogenous cortisol, unmasking borderline ACTH deficiency and leading to the development of adrenal insufficiency and adrenal crisis. In addition, growth hormone can enhance the metabolism of thyroxine to triiodothyronine, uncovering borderline TSH deficiency. In many patients, thyroid hormone replacement therapy must be started, or the dose of levothyroxine must be increased. Oral estrogen replacement therapy leads to a state of relative growth hormone resistance, and the dose of GH may need to be increased substantially. Physicians have long been cognizant of the fact that adding a new prescription medication may lead to important drug-drug interactions. Starting growth hormone therapy may lead to hormone-hormone interactions that can pose serious complications for the hypopituitary patient unless the interaction of growth hormone on other pituitary hormone systems is understood.



中文翻译:

用生长激素治疗成人生长激素缺乏综合征:其他垂体功能低下的激素替代疗法有什么意义?

启动生长激素替代疗法时,考虑患者的其他垂体激素替代药物非常重要,因为通常需要进行调整。生长激素疗法可增加氢化可的松或内源性皮质醇的代谢,从而掩盖ACTH的临界边界,并导致肾上腺皮质功能不全和肾上腺危机的发展。此外,生长激素可以增强甲状腺素向三碘甲状腺素的代谢,从而揭示了TSH的临界缺陷。在许多患者中,必须开始甲状腺激素替代疗法,或者必须增加左甲状腺素的剂量。口服雌激素替代疗法导致相对生长激素抵抗的状态,GH的剂量可能需要大量增加。长期以来,医师一直意识到添加新的处方药可能导致重要的药物相互作用。开始生长激素治疗可能会导致激素-激素相互作用,对垂体下垂患者可能造成严重的并发症,除非了解生长激素在其他垂体激素系统上的相互作用。

更新日期:2020-03-23
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