ometendoОжирение и метаболизмObesity and metabolism2071-87132306-5524Endocrinology Research Centre10.14341/2071-8713-4947ometendo-4947Research ArticleСтатьиArticlesПриобретённая недостаточность гормона роста у взрослых: этиология, клинические проявления, диагностика и возможности леченияPriobretennaya nedostatochnost' gormona rosta u vzroslykh: etiologiya, klinicheskie proyavleniya, diagnostika i vozmozhnosti lecheniyaVaksVladimir Vladimirovich

д.м.н.

vaks_1@hotmail.comGerasimenkoOlga Aleksandrovnaolga84@yandex.ruDzeranovaLarisa Konstantinovna

д.м.н., ученый секретарь

metabol@endocrincentr.ruФГБУ "Эндокринологический научный центр" Минздравсоцразвития России, МоскваРоссияEndocrinology Research Centre, MoscowRussian Federation20111506201182№2 (2011)1117Copyright © Vaks V.V., Gerasimenko O.A., Dzeranova L.K., 20112011Vaks V.V., Gerasimenko O.A., Dzeranova L.K.Vaks V.V., Gerasimenko O.A., Dzeranova L.K.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.omet-endojournals.ru/jour/article/view/4947

Приобретённая недостаточность соматотропного гормона роста (СТГН) у взрослых все ещё остается одной из актуальных проблем в эндокринологии. В данной статье, адресованной практическому врачу, рассмотрены вопросы физиологии гормона роста у взрослых, а также этиология и диагностика приобретенной СТГН во взрослом возрасте. Инсулинотолерантный тест (ИТТ) считается всеми зарубежными и отечественными научными обществами «золотым» стандартом в диагностике СТГН у взрослых наряду с комбинированным тестом (гонадотропин-рилизинг гормон (ГтРГ) + аргинин). В статье приведены результаты клинических исследований относительно влияния дефицита гормона роста у взрослых на обмен веществ и качество жизни, а также рассмотрена эффективность заместительной терапии гормоном роста на различные клинические проявления СТГН у взрослых. Представлены основные принципы заместительной терапии препаратами гормона роста, схема дозирования, возможные побочные эффекты и тактика дальнейшего наблюдения.

Adult-onset growth hormone deficiency (GHD) remains one of the issues in clinical endocrinology. In this article, which is addressed to practitioners, physiology of growth hormone in adults is reviewed along with etiology and diagnostic criteria of this medical condition. In general, a stimulation test is required to recognize GHD. Insulin tolerance test (ITT) has been considered the gold standard by the most important scientific societies, although alternative tests, in particular GHRH plus arginine have been proposed as valuable alternative to ITT. The results of different clinical studies regarding the impact of adult-onset GH-deficiency on metabolism and quality of life are summarized and beneficial effects of growth hormone replacement therapy on many of the manifestations of GHD reviewed. The management of GHD in adults is discussed including initiation of GH treatment, dose titration and assessment of response during trail period.

гормон ростасоматотропная недостаточность у взрослыхСТГ-недостаточностьгипопитуитаризмgrowth hormonеgrowth hormone deficiency in adultshypopituitarismReferencesДиагностика и лечение приобретенной недостаточности гормона роста у взрослых / И.И.Дедов, В.В. Вакс, Е.И. Марова. - М., 2001.Диагностика и лечение приобретенной недостаточности гормона роста у взрослых / И.И.Дедов, В.В. Вакс, Е.И. Марова. - М., 2001.Evaluation and treatment of Adult Growth Hormone Deficiency: An Endocrine Society Clinical Practice Guideline // The Journal of Clinical Endocrinology & Metabolism. - V. 91. - Р. 1621-1634Evaluation and treatment of Adult Growth Hormone Deficiency: An Endocrine Society Clinical Practice Guideline // The Journal of Clinical Endocrinology & Metabolism. - V. 91. - Р. 1621-1634AACE Medical Guidelines for clinical practice for growth hormone use in growth hormone -deficient adults and transition patients - 2009 Update // ENDOCRINE PRACTICE. - 2009. - V. 15 (Suppl 2) September/October.AACE Medical Guidelines for clinical practice for growth hormone use in growth hormone -deficient adults and transition patients - 2009 Update // ENDOCRINE PRACTICE. - 2009. - V. 15 (Suppl 2) September/October.Markussis V., Beshyah S.A., Fisher C., Sharp P., Nicolaides A.N., Johnston D.G. Detection of premature atherosclerosis by high-resolution ultrasonography in symptom-free hypopituitary adults // Lancet. - 1992. - № 340. - Р. 1188-1192.Markussis V., Beshyah S.A., Fisher C., Sharp P., Nicolaides A.N., Johnston D.G. Detection of premature atherosclerosis by high-resolution ultrasonography in symptom-free hypopituitary adults // Lancet. - 1992. - № 340. - Р. 1188-1192.McGauley G.A., Cuneo R.C., Salomon F., Sonksen P.H. Psychological well-being before and after growth hormone treatment in adults with growth hormone deficiency // Horm Res. - № 33. - Р. 52-54.McGauley G.A., Cuneo R.C., Salomon F., Sonksen P.H. Psychological well-being before and after growth hormone treatment in adults with growth hormone deficiency // Horm Res. - № 33. - Р. 52-54.Binnerts A., Swart G.R., Wilson J.H.P. et al. The effect of growth hormone administration in growth hormone deficient patients on bone, protein, carbohydrate and lipid homeostasis as well as on body composition // Clin Endocrinol. - 1992. - № 37. - Р. 79-87.Binnerts A., Swart G.R., Wilson J.H.P. et al. The effect of growth hormone administration in growth hormone deficient patients on bone, protein, carbohydrate and lipid homeostasis as well as on body composition // Clin Endocrinol. - 1992. - № 37. - Р. 79-87.Jorgensen J.O.L., Pedersen S.A., Thuesen L. et al. Beneficial effects of growth hormone in GH-deficient adults // Lancet. - 1989. - № 1. - Р. 1221-5.Jorgensen J.O.L., Pedersen S.A., Thuesen L. et al. Beneficial effects of growth hormone in GH-deficient adults // Lancet. - 1989. - № 1. - Р. 1221-5.Gibney J., Wallace J.D., Spinks T. et al. The effect of 10 years of recombinant human growth hormone (GH) in adult GH-deficient patients // J Clin Endocrinol Metab. - 1999. - № 84. - Р. 2596-2602.Gibney J., Wallace J.D., Spinks T. et al. The effect of 10 years of recombinant human growth hormone (GH) in adult GH-deficient patients // J Clin Endocrinol Metab. - 1999. - № 84. - Р. 2596-2602.Taafe D.R., Pruitt L., Reim J., Hintz R., Buttereld G., Hoffman A.R., Marcus R. Effect of recombinant human growth hormone on the muscle strength response to resistance exercise in elderly men // Journal of Clinical Endocrinology and Metabolism. - 1994. - № 79. - Р. 1361-1366.Taafe D.R., Pruitt L., Reim J., Hintz R., Buttereld G., Hoffman A.R., Marcus R. Effect of recombinant human growth hormone on the muscle strength response to resistance exercise in elderly men // Journal of Clinical Endocrinology and Metabolism. - 1994. - № 79. - Р. 1361-1366.Bengtooon B-A., Eden S., Lonn L. et al. Treatment of adults with growth hormone (GH) deficiency with recombinant human GH // J Clin Endoc Metab. - 1993. - № 76. - Р. 309-315.Bengtooon B-A., Eden S., Lonn L. et al. Treatment of adults with growth hormone (GH) deficiency with recombinant human GH // J Clin Endoc Metab. - 1993. - № 76. - Р. 309-315.Powrie J., Weissberger A., Sonksen P. Growth hormone replacement therapy for growth hormone-deficient adults // Drugs. - 1995. - № 49. - Р. 656-663.Powrie J., Weissberger A., Sonksen P. Growth hormone replacement therapy for growth hormone-deficient adults // Drugs. - 1995. - № 49. - Р. 656-663.Burman P., Deijen J.B. Quality of life and cognitive function in patients with pituitary insufficiency // Psycother Psychosom. - 1998. - № 67. - Р. 154-167.Burman P., Deijen J.B. Quality of life and cognitive function in patients with pituitary insufficiency // Psycother Psychosom. - 1998. - № 67. - Р. 154-167.McGauley G.A., Cuneo R.C., Salomon F. et al. Growth hormone deficiency and quality of life // Horm Res. - 1996. - № 45. - Р. 34-37.McGauley G.A., Cuneo R.C., Salomon F. et al. Growth hormone deficiency and quality of life // Horm Res. - 1996. - № 45. - Р. 34-37.Hunt S.M., McKenna S.P., Doward L.C. Preliminary report on the development of a disease-specific instrument for assessing quality of life of adults with growth hormone deficiency // Acta Endocrinol. - 1993. - № 128. - Р. 37-40.Hunt S.M., McKenna S.P., Doward L.C. Preliminary report on the development of a disease-specific instrument for assessing quality of life of adults with growth hormone deficiency // Acta Endocrinol. - 1993. - № 128. - Р. 37-40.Hoffman A.R., Strasburger C.J., Zagar A., Blum W.F., Kehely A., Hartman M.L. T002 Study Group. Efficacy and tolerability of an individualized dosing regimen for adult growth hormone replacement therapy in comparison with fixed body weightbased dosing // J Clin Endocrinol Metab. - 2004. - № 89. - Р. 3224-3233.Hoffman A.R., Strasburger C.J., Zagar A., Blum W.F., Kehely A., Hartman M.L. T002 Study Group. Efficacy and tolerability of an individualized dosing regimen for adult growth hormone replacement therapy in comparison with fixed body weightbased dosing // J Clin Endocrinol Metab. - 2004. - № 89. - Р. 3224-3233.Ho K.Y., Evans W.S., Blizzard R.M., et al. Effects of sex and age on the 24-hour profile of growth hormone secretion in man: importance of endogenous estradiol concentrations // J Clin Endocrinol Metab. - 1987. - № 64. - Р. 51-58.Ho K.Y., Evans W.S., Blizzard R.M., et al. Effects of sex and age on the 24-hour profile of growth hormone secretion in man: importance of endogenous estradiol concentrations // J Clin Endocrinol Metab. - 1987. - № 64. - Р. 51-58.AACE Clinical practice Guidelines for growth hormone use in adults and children // Am Ass Clin Endocrinol and Am Coll Endocrinol. - 1998.AACE Clinical practice Guidelines for growth hormone use in adults and children // Am Ass Clin Endocrinol and Am Coll Endocrinol. - 1998.Cuneo R.C., Salomon F., Wiles C.M. et al. Skeletal muscle performance in adults with growth hormone deficiency // Horm Res. - 1990. - № 33. - Р. 55-60.Cuneo R.C., Salomon F., Wiles C.M. et al. Skeletal muscle performance in adults with growth hormone deficiency // Horm Res. - 1990. - № 33. - Р. 55-60.Rosen T., Wiren L., Wilhelmsen L., Wiklund I., Bengtsson B.A. Decreased physiological well-being in adult patients with growth hormone deficiency // Clin Endocrinol. - 1994. - № 40. - Р. 111-116.Rosen T., Wiren L., Wilhelmsen L., Wiklund I., Bengtsson B.A. Decreased physiological well-being in adult patients with growth hormone deficiency // Clin Endocrinol. - 1994. - № 40. - Р. 111-116.Binnerts A., Deurenberg P., Swart G.R. et al. Body composition in growth hormone-deficient adults // Am J Clin Nutr. - 1992. - № 55. - Р. 918-923.Binnerts A., Deurenberg P., Swart G.R. et al. Body composition in growth hormone-deficient adults // Am J Clin Nutr. - 1992. - № 55. - Р. 918-923.Cuneo R.C., Salomon F., McGauley G.A., Sonksen P.H. The growth hormone deficiency syndrome in adults // Clin Endocrinol. - 1992. - № 37. - Р. 387-397.Cuneo R.C., Salomon F., McGauley G.A., Sonksen P.H. The growth hormone deficiency syndrome in adults // Clin Endocrinol. - 1992. - № 37. - Р. 387-397.Baum H.B.A., Katznelson L., Sherman J.C. et al. Effects of physiological growth hormone (GH) therapy on cognition and quality of life in patients with adult-onset GH deficiency // J Clin Endoc Metab. - 1998. - № 83. - Р. 3184-3189.Baum H.B.A., Katznelson L., Sherman J.C. et al. Effects of physiological growth hormone (GH) therapy on cognition and quality of life in patients with adult-onset GH deficiency // J Clin Endoc Metab. - 1998. - № 83. - Р. 3184-3189.Powrie J., Weissberger A., Sonksen P. Growth hormone replacement therapy for growth hormone-deficient adults // Drugs. - 1995. - № 49. - Р. 656-663.Powrie J., Weissberger A., Sonksen P. Growth hormone replacement therapy for growth hormone-deficient adults // Drugs. - 1995. - № 49. - Р. 656-663.Hoffman D.M., O'Sullivan A.J., Baxter R.C., Ho K.K.Y. Diagnosis of growth hormone deficiency in adults // Lancet. - 1994. - № 343. - Р. 1064-1068.Hoffman D.M., O'Sullivan A.J., Baxter R.C., Ho K.K.Y. Diagnosis of growth hormone deficiency in adults // Lancet. - 1994. - № 343. - Р. 1064-1068.Rosen T., Bosaeus I., Tolli J. et al. Increased body fat mass and decreased extracellular fluid volume in adults with growth hormone deficiency // Clin Endocrinol. - 1993. - № 38. - Р. 63-71.Rosen T., Bosaeus I., Tolli J. et al. Increased body fat mass and decreased extracellular fluid volume in adults with growth hormone deficiency // Clin Endocrinol. - 1993. - № 38. - Р. 63-71.Hoffman D.M., O'Sulivan A.J., freund J., Ho K.K. Adults with growth hormone deficiency have abnormal body composition but normal energy metabolism // J Clin Endoc Metab. - 1995. - № 80. - Р. 72-77.Hoffman D.M., O'Sulivan A.J., freund J., Ho K.K. Adults with growth hormone deficiency have abnormal body composition but normal energy metabolism // J Clin Endoc Metab. - 1995. - № 80. - Р. 72-77.Snel Y.E., Doerga M.E., Brummer R.J. et al. Resting metabolic rate, body composition and related hormonal parameters in growth hormone-deficient adults before and after growth hormone replacement therapy // Eur J Endocrinol. - 1995. - № 133. - Р. 445-450.Snel Y.E., Doerga M.E., Brummer R.J. et al. Resting metabolic rate, body composition and related hormonal parameters in growth hormone-deficient adults before and after growth hormone replacement therapy // Eur J Endocrinol. - 1995. - № 133. - Р. 445-450.Wuster C., Abs R., Bengtsson B-A. et al. The influence of growth hormone (GH) deficiency, GH replacement therapy and other aspects of hypopituitarism on bone mineral density and fracture rate: evidence from a large-scale pharmacoepidemiological survey // KIMS abstracts. - 1999.Wuster C., Abs R., Bengtsson B-A. et al. The influence of growth hormone (GH) deficiency, GH replacement therapy and other aspects of hypopituitarism on bone mineral density and fracture rate: evidence from a large-scale pharmacoepidemiological survey // KIMS abstracts. - 1999.Evaluation and treatment of Adult Growth Hormone Deficiency: An Endocrine Society Clinical Practice Guideline // The Journal of Clinical Endocrinology & Metabolism. - 2011. - № 96 (6). - Р. 1587-1609Evaluation and treatment of Adult Growth Hormone Deficiency: An Endocrine Society Clinical Practice Guideline // The Journal of Clinical Endocrinology & Metabolism. - 2011. - № 96 (6). - Р. 1587-1609

The authors declare that there are no conflicts of interest present.