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 .
Baseline characteristics and the effects of five years of GH replacement therapy in adults with GH deficiency of childhood or adulthood onset: a comparative, prospective study.
The consequences of GH deficiency may differ if the disease is childhood onset or adulthood onset . In this single-center , prospect i ve study , 21 consecutive adults with childhood onset GH deficiency and 21 adults with adulthood onset GH deficiency , matched for age , gender , body mass index , and number of anterior pituitary hormonal deficiencies , were included . Baseline differences and differences in the responses in body composition , muscle strength , bone mass , and metabolic indices during 5-yr GH replacement were determined . The duration of GH deficiency was longer and serum IGF-I level and body height were lower in the childhood onset patients than in the adulthood onset patients . Body fat ( observed/predicted ratio ) was increased , and lean mass and muscle strength were decreased , in the childhood onset patients . Total body and lumbar ( L2-L4 ) bone mineral content and bone mineral density were lower in the childhood onset patients . Serum total cholesterol level was higher in the adulthood onset patients . The childhood onset and adulthood onset patients received a similar dose of GH . After adjustment for body weight , however , the dose of GH was higher in the childhood onset patients . The treatment responses were more marked in the childhood onset patients in lean mass , knee extensor strength , left-h and grip strength , and in total body and lumbar ( L2-L4 ) bone mineral content and bone mineral density . The reduction in serum total cholesterol concentration was more marked in the adulthood onset patients . At study end , no differences remained between the two study groups after the correction for body height in the statistical analysis . In conclusion , the baseline analysis suggests more decreased lean mass , muscle strength , and bone mass in the childhood onset patients whereas the lipid profile was more disturbed in the adulthood onset patients . The 5-yr GH replacement eliminated all the anthropodometric and metabolic differences between the two groups
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 .