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Neuroendocrine and Pituitary
Tumor Clinical Center (NEPTCC) Bulletin

Winter 2016/2017 | Volume 23, Issue 1

Understanding Growth Hormone Deficiency in HIV Lipodystrophy

Suman Srinivasa, MD

Perturbations in the growth hormone (GH) axis are common among the well-treated human immunodeficiency virus (HIV)-infected population [1]. Acquired GH deficiency (GHD) secondary to HIV is a clinical diagnosis in the absence of known pituitary or hypothalamic pathology and should be differentiated from idiopathic adult GHD. Studies have determined that a GH peak cutoff of 7.5 ng/mL during the GHRH-arginine test can adequately discriminate GHD in HIV-infected individuals compared to healthy individuals with good specificity. As much as a third of HIV-infected individuals are estimated to have an inappropriate response to GHRH-arginine stimulation testing [2].

A spectrum of disease from true GHD to GH insufficiency exists among the HIV population. Recent studies have reported that the severity of GHD is far greater in the setting of pituitary disease compared to HIV infection [3], as measured by peak GH and area under the curve GH during GHRH-arginine testing. When an abnormally low IGF-1 is detected, it may be prudent to formally rule out pituitary insufficiencies and determine whether pituitary imaging is warranted; however, in most scenarios, the GHD may likely be ascribed to a known history of HIV.

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