Available online 28 August 2023, 101820

Author links open overlay panel, ABSTRACT

Growth hormone is among the most common hormones to be deficient in pituitary insult. It can occur either in isolation or combined with other hormone deficiencies. Growth hormone deficiency in adults (AGHD) can be due to causes acquired in adulthood or have a childhood-onset etiology, but the former is about three times more common. Usual causes of AGHD include mass effects due to a pituitary tumour, and/or its treatment (surgery, medical therapy, or radiotherapy), or radiotherapy to the head and neck region for non-pituitary lesions. The unusual or lesser-known causes of AGHD, are usually due to non-tumoral etiology and range from vascular and infective to inflammatory and miscellaneous causes. These not only expand the spectrum of AGHD but may also contribute to increased morbidity, adverse metabolic consequences, and mortality in the primary condition, if unrecognised. The review features these lesser-known and rare causes of AGHD and highlights their clinical and diagnostic implications.

Section snippetsCase vignette

A 33-year-old female presented to the adult endocrinology clinic with polyuria-polydipsia and a preference for cold liquids at 28 years of age, 18 months following the delivery of her second child (Fig. 1). She had noticed an onset of symptoms 1 year following delivery. She also complained of an intermittent dull headache, diarrhoea, and weight loss (nearly 10 kg over 4 months). Her past medical history was otherwise unremarkable. Menstrual cycles were normal. On examination, her stature was

Background

Growth hormone is among the most common hormones to be affected in the event of pituitary insult. It is affected in nearly 50 to 72% of cohorts with hypopituitarism [1], [2], [3]. Growth hormone is one of the earliest to be involved in various pituitary insults, hence it may be an isolated deficiency or occur concurrently with other hormone deficiencies. Though AGHD may be due to childhood-onset or acquired adult-onset causes, the latter is the predominant contributor to AGHD (almost 77% in the

Clinical perspective

Growth hormone deficiency resulting from usual causes such as a pituitary adenoma and/or its management is more likely to be recognised, diagnosed, and managed earlier than GHD due to an unusual cause. The symptoms of GHD due to an unusual cause are non-specific, and the onset, progression variable, which compounds the complexity and challenges. Notwithstanding, diagnosis of GHD due to less common causes should be individualised, based on signs/symptoms and associated features of the underlying

SUMMARY

GHD in adults is most commonly caused by a pituitary adenoma and/or its therapy. Unusual causes of GHD are mostly non-tumoral and comprise a heterogeneous spectrum, including infective, vascular, traumatic, inflammatory, and other rare causes. The bottom line for GHD in all these settings is that it may be present in acute settings or on follow-up, often underestimated due to less focus on its diagnosis in acute settings (as it is not a life-saving hormone) as well as lack of robust definitive

Uncited references

[49], [78]

Funding

There was no funding for the manuscript.

Conflict of interest

The authors have no conflicts of interest to declare.

Acknowledgment

We wish to thank Prof. Uma Nahar Saikia, Department of Histopathology, PGIMER Chandigarh for providing the histopathological images of the case of GHD due to celiac disease.

We also wish to thank Mr. Brijlal Badhan, Senior Technical Officer, Department of Clinical Photography, PGIMER Chandigarh.

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