A positive effect of GH treatment on CVD and fracture risk could be concluded , but study design limitations have to be considered .
Stroke and secondary brain tumours remained more prevalent .
Regrowth and recurrences of (peri)pituitary tumours were not increased in patients with GH treatment compared to similar patients without GH treatment .
All fatal and nonfatal malignancies were not more prevalent in  GH-treated adults compared to the general population .
Due to the positive effects demonstrated in r and omized clinical trials on cardiovascular surrogate markers and bone metabolism , a positive effect of growth hormone ( GH ) treatment on clinical ly relevant end-points seems feasible .
In this review , we discuss the long-term efficacy and safety of GH treatment in adult patients with growth hormone deficiency ( GHD ) with emphasis on morbidity : fatal and nonfatal cardiovascular disease ( CVD ) and stroke , fractures , fatal and nonfatal malignancies and recurrences , and diabetes mellitus .
BENEFICIAL EFFECTS OF GROWTH HORMONE TREATMENT IN GH-DEFICIENT ADULTS
A double-blind , placebo-controlled , crossover study on the effects of 4 months ' growth hormone ( GH ) treatment was carried out in 22 GH-deficient adults ( 8 women , 14 men ; mean [ SEM ] age 23.8 [ 1.2 ] years ) . 1 patient was withdrawn because of oedema . Mean total body weight of the other 21 did not change , whereas mean muscle volume of the thigh , estimated by computerised tomography ( CT ) , was significantly higher after GH than after placebo ( 70.0 [ 3.7 ] vs 66.3 [ 3.1 ] ml/0.8 cm cross-sectional slice ) . The mean adipose tissue volume of the thigh and subscapular skinfold thickness fell significantly during GH treatment . Growth hormone caused a small increase in the isometric strength of the quadriceps muscles and a significant rise in exercise capacity ( 60.8 [ 7.2 ] vs 54.2 [ 6.6 ] kJ ) . The heart rate both at rest and after maximum exercise was low during the placebo period and increased significantly during GH treatment . Blood pressure and echocardiographic wall mass of the left ventricle did not change during the study . Growth hormone increased both mean glomerular filtration rate and renal plasma flow from a subnormal level on placebo to a level comparable with that of an age-matched control group . The filtration fraction did not change . Urinary albumin excretion was in the low normal range and was not affected by GH treatment . Finally , GH treatment normalised mean circulating levels of insulin-like growth factor 1 ( IGF-1 ) , which were low after the placebo period ( 96 [ 9 ] micrograms/l placebo ; 224 [ 28 ] micrograms/l GH ) . These findings suggest that GH , in a conventional replacement dose , has several potentially beneficial effects in GH-deficient adults and therefore encourage future long-term trials
A positive effect of GH treatment on CVD and fracture risk could be concluded , but study design limitations have to be considered .
Stroke and secondary brain tumours remained more prevalent .
Regrowth and recurrences of (peri)pituitary tumours were not increased in patients with GH treatment compared to similar patients without GH treatment .
All fatal and nonfatal malignancies were not more prevalent in  GH-treated adults compared to the general population .
Due to the positive effects demonstrated in r and omized clinical trials on cardiovascular surrogate markers and bone metabolism , a positive effect of growth hormone ( GH ) treatment on clinical ly relevant end-points seems feasible .
In this review , we discuss the long-term efficacy and safety of GH treatment in adult patients with growth hormone deficiency ( GHD ) with emphasis on morbidity : fatal and nonfatal cardiovascular disease ( CVD ) and stroke , fractures , fatal and nonfatal malignancies and recurrences , and diabetes mellitus .