HGH Doctor: Real Medical Facts from Real Medical Journals

Side Effects of Growth Hormone (GH)

• In the initial clinical trials, which were composed predominantly of adults with adult-onset growth hormone deficiency (GHD), starting doses of GH were higher than those now recommended. The most common side effects during initiation of GH replacement therapy were fluid retention in conjunction with edema of the extremities, carpal tunnel syndrome, arthralgia, and myalgia. In a study of 115 adult patients with GHD who were given GH replacement therapy for 6 months, edema developed in 37.4%, arthralgia in 19.1%, myalgia in 15.7%, paresthesias in 7.8%, and carpal tunnel syndrome in 1.7%. Of note, these symptoms most commonly occurred at the outset of therapy, and most symptoms resolved within 1 to 2 months while therapy was continued.
• Arthralgia, myalgia, and carpal tunnel syndrome are more frequent in adults but occur occasionally in GH-treated children. Peripheral edema is also more frequent in adults than in younger patients receiving GH therapy. Pseudotumor cerebri or benign intracranial hypertension, however, may occur more frequently in children. The US Food and Drug Administration (FDA) has received reports of 23 cases of benign intracranial hypertension associated with GH replacement; only 1 of these cases has been in an adult. In all cases, papilledema and symptoms of intracranial hypertension (for example, headaches) resolved after GH replacement therapy was discontinued. Only a few of the patients who resumed GH therapy experienced recurrent headaches and papilledema.
• Slipped capital femoral epiphysis may occur more frequently in children with GHD than in others. Investigators are uncertain whether GH has this effect or whether this problem is the result of a diathesis induced by the condition of GHD, exacerbated by rapid growth. GH treatment has been suggested to increase the incidence of this problem. If treated with GH, children with knee or hip pain or with a limp should be carefully examined for slipped capital femoral epiphysis.
• Occasionally, lipoatrophy may occur in GH injection sites, but this finding is relatively uncommon. Some reports suggest that GH may increase creatinine levels in patients with end-stage renal disease. This phenomenon is more frequent in renal transplant recipients and may reflect increased risk of graft rejection.
• GH induces transient resistance to the actions of insulin. In most patients, this action of GH increases circulating levels of insulin but not of glucose. In patients with limited insulin reserve, however, glucose intolerance may result. The GH effect on glycemia also should be monitored periodically by measurement of glycated hemoglobin levels. Several cases of pancreatitis associated with GH therapy have been reported. The precise cause for this complication in GH treatment is uncertain.
• Reports from Japan initially suggested an increased incidence of leukemia in GH-treated patients; however, subsequent studies have not confirmed such an increase. Careful studies in the United States have not confirmed an increased frequency of leukemia attributable to GH therapy. A major unanswered question is whether GH treatment further increases the incidence of leukemia in patients with other risk factors for leukemia (such as patients who previously have received radiation therapy).
• The development of colonic neoplasms in patients with acromegaly has raised the question of whether GH therapy is associated with tumorigenesis. The Growth Hormone Research Society recently reviewed this subject extensively; they concluded that GH therapy is not associated with the promotion of pituitary tumor recurrence or the development of any other neoplasm. Benign pituitary tumors have long been known to be associated with a 10% recurrence rate during the 10-year period after surgical removal. GH therapy does not affect the risk of recurrence. Although no available evidence indicates that GH stimulates tumor recurrence, a baseline pituitary scan before initiation of therapy is warranted. No additional monitoring for other malignant tumors (such as tumors of the prostate, breast, or colon) is currently suggested beyond the accepted standard of care for the patientīs age and sex.
• Transient gynecomastia has been described in children and adults during GH replacement therapy.