Growth hormone deficiency in treated acromegaly

• Growth hormone deficiency (GHD) may arise in patients with previous acromegaly as a consequence of overly effective neurosurgery and/or radiotherapy.
• The insulin-tolerance test is the gold standard for diagnosis of GHD, and the response is independent of previous cranial irradiation for hypothalamic-pituitary tumors.
• The GH releasing hormone+arginine test is as effective as the insulin-tolerance test for diagnosing GHD in acromegaly patients treated by neurosurgery, as well as in those treated by radiotherapy 5 years following irradiation.
• Patients who develop GHD after treatment of acromegaly may have an impairment of cardiovascular health and quality of life.
• The risk/benefit ratio of replacement therapy for GHD in patients with a history of acromegaly is still uncertain.

Growth hormone deficiency (GHD) of the adult is characterized by reduced quality of life (QoL) and physical fitness, skeletal fragility, and increased weight and cardiovascular risk. Hypopituitarism may develop in patients after definitive treatment of acromegaly, but an exact prevalence of GHD in this population is still uncertain owing to limited awareness and the scarce and conflicting data available on this topic. Because acromegaly and GHD may yield adverse consequences on similar target systems, the final outcomes of some complications of acromegaly may be further affected by the occurrence of GHD. However, it is still largely unknown whether patients with post-acromegaly GHD may benefit from GH replacement. We review the diagnostic, clinical, and therapeutic aspects of GHD in adult patients treated for acromegaly.