Therapeutic target
The goal of STH substitution therapy is:
- Raise serum IGF-1 concentrations to the mid-normal range – 50th percentile (200-210 ng/ml) – of a healthy 25- to 30-year-old plus.
- By STH deficiency (growth hormone deficiency) caused complaints or disorders to remedy or alleviate.
Therapy recommendations
- STH substitution (growth hormone replacement therapy).
Indications (areas of application)
A distinction is made between STH substitution for the following indications:
- True growth hormone deficiency, e.g., due to diseases or situations such as pituitary surgery, severe traumatic brain injury (TBI) or therapeutic radiotherapy to the brain, anterior pituitary hypofunction
- Age- or lifestyle-dependent growth hormone deficiency.
Unlike true growth hormone deficiency, costs for the therapy of age- or lifestyle-dependent growth hormone deficiency are not covered by health insurance!
Contraindications
Currently known exclusion criteria or absolute contraindications include:
- Manifest malignant tumor disease – e.g., colon carcinoma (colon cancer), prostate carcinoma (prostate cancer), breast carcinoma (breast cancer).
- High familial tumor risk
- Decompensated diabetes mellitus
- Severe organ disease, metabolic syndrome
- Proliferative retinopathy (retinal disease).
- Intracranial hypertension
Decision after risk-benefit assessment in:
- Diabetes mellitus
- Condition after carcinoma (cancer)
- Condition after adenoma
- Metabolic disorders
- Edema
- Acute thromboembolic diseases
- Condition after thrombosis or embolism
- Condition after myocardial infarction (heart attack)
- Chronic heart failure (cardiac insufficiency)
Based on data from the HypoCCS (Hypopituitary Control and Complications Study) study of somatropin treatment data in patients with panhypopituitarism collected between 1996 and 2012, after a follow-up period of 4.8 years on average, both breast carcinoma in women and prostate tumors and colorectal carcinomas were not more common in treated than in untreated patients.
Mode of action
Growth hormone has multiple effects:
- Insulin synergistic effects
- Antagonistic to insulin
- Inhibition of glucose utilization – especially in the muscles – possible development of glucose intolerance (inadequate regulation of blood glucose after oral glucose intake).
- Stimulation of hepatic gluconeogenesis (“new sugar formation”).
- Inhibition of lipogenesis (“fat formation”).
- Stimulation of lipolysis (fat cleavage) – degradation of adipose tissue.
- Increased insulin and glucagon secretion Glucagon causes: glycogenolysis (glycogen breakdown), proteolysis (protein breakdown) and insulin secretion!
- Osteotropic effects – stimulation of bone formation.
- Favorable effects on wound healing
- Regeneration of the skin
- Increasing the function of the immune system
- Increase in memory performance
- More stable psyche
- Improvement of the general well-being
- Increase heart function
In cases of proven growth hormone deficiency, the following therapeutic options should be used first:
Stimulation of endogenous nocturnal STH release by:
- Dinner cancelling and fasting – hypoglycemia is the most potent stimulator of growth hormone secretion.
- Sports activity – performance-enhancing fitness training – progressive muscle activity – can additionally improve the secretion of growth hormone
- Weight reduction
- Improving sleep hygiene, sleep quality and duration.
- Stress reduction and management
- Micronutrient therapy (vital substances) – within the framework of micronutrient medicine (vital substances)* amino acids – arginine and lysine are used.
- DHEA, testosterone, estrogens
- Avoidance of drugs with STH-inhibitory effects – corticosteroids, aminophylline, theophyllines, ergotamine alkaloids, morphine, apomorphine, bromocryptine, methylsergide, cyproheptadine, phenoxybenzamine, phentolamine, tolazoline, reserpine, chlorpromazine.
* Prevention and therapy with micronutrients (vital substances). The vital substances (micronutrients) include vitamins, minerals, trace elements, vital amino acids, vital fatty acids, etc..
Growth Hormone Replacement Therapy
In men in somatopause, compensation for a testosterone hormone deficiency – if andropause symptoms are present – should first be undertaken before any growth hormone therapy, since testosterone itself has a stimulating effect on the synthesis and secretion of STH (growth hormone). STH – Growth Hormone Substitution Therapy
The goal of STH substitution therapy is to generally raise serum IGF-1 concentrations to the mid-normal range – 50th percentile (200-210 ng/ml) – of a healthy 25 to 30 year old. Today, the therapy is carried out with approved genetically engineered growth hormone. The hormone is identical to the hormone produced in the pituitary gland and its production via bacteria or individual cells protects against any infection. Caution. Substances available on the Internet or even sprays are not recommended! Substitution therapy should also be initiated and monitored by a physician trained in endocrinology.
Dosage information
Injections are nowadays performed with a fountain pen-like injection device (PEN), and handling is very simple. Daily injections are given subcutaneously-that is, under the skin-in the evening hours at an initial dosage of approximately 0.1-0.2 mg/day.Depending on the patient’s condition, side effects, and progression of IGF-1 levels, the dosage can be increased to the lowest possible maintenance dose. First improvements of the symptom complex of an anamnestically recorded and clinically determined STH deficiency syndrome should already be observed after 6 months of therapy. In this regard, a number of the intended effects of successful STH therapy can be observed after only a few weeks.
Potential side effects
- Water retention (water retention) – edema, arthralgia (joint pain), joint stiffness, myalgia (muscle pain) – at the beginning of therapy Cause: side effects are due to compensation of extracellular volume deficit. Frequency: > 1% and < 40%; frequency depends on age and dose.
- Carpal tunnel syndrome Frequency: Rare – > 0.1 and < 1 %.
- Intracranial hypertension – recurrent headache, visual disturbances, nausea (nausea), vomiting If suspected: funduscopy to exclude papilledema Frequency: isolated cases Recommendation: discontinue therapy immediately!
- Thyroid dysfunction – development of hypothyroidism (hypothyroidism), in treatment with L-thyroxine also hyperthyroidism; Cause: Increased conversion of T4 to T3 Recommendation: control of thyroid function before starting therapy.
- Insulin resistance and in individual cases hyperglycemia to the development of diabetes mellitus type 2; occurrence more often with predisposition: obesity, genetic disposition, steroid treatment or existing glucose intolerance.
- Patients with diabetes mellitus – here may require adjustment of the dose of the antidiabetic drug.
- In case of m-cresol intolerance – a solution preservative used – switch to a wax hormone preparation without m-cresol. Typical side effects of m-cresol incompatibility: myositis with myalgia (muscle pain) as well as severe pain at the injection site.
For other possible side effects, please refer to the respective instructions for use.
