Is GH Replacement for Adult GH Deficiency Safe?
Since the description of adult GH deficiency (AGHD) as a distinct disorder associated with pituitary failure, as well as the availability of recombinant human GH, endocrinologists have been treating these patients with replacement GH at doses ranging from 0.15 to 0.3 mg/d, and higher in younger women.

Extensive surveillance studies have reported on GH side effects including salt and fluid retention, edema, carpal tunnel syndrome, hyperglycemia, arthralgias, myalgias, paresthesias, atrial fibrillation, headache, and sleep apnea, in addition to signs and symptoms from unmasking thyroid and/or adrenal dysfunction.

An observational study of 5.3 years mean duration, with only 19% of patients followed for >10 years, the reported new findings are reassuring that the approved practice of carefully titrated physiologic GH replacement doses for well-defined AGHD are indeed safe and tolerable in patients with proven pituitary dysfunction. It would, however, be irresponsible to derive reinforcement for the inappropriate and illegal use of GH in pituitary-replete individuals or in aging, or to enhance athletic performance from results of this carefully analyzed cohort surveillance. In their well-designed and comprehensive analysis, Johansson et al bolster the clinical relevance of current guidelines for safe and effective GH replacement for AGHD.