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 .
Prospective Safety Surveillance of GH-Deficient Adults: Comparison of GH-Treated vs Untreated Patients
Context : In clinical practice , the safety profile of GH replacement therapy for GH-deficient adults compared with no replacement therapy is unknown . Objective : The objective of this study was to compare adverse events ( AEs ) in GH-deficient adults who were GH-treated with those in GH-deficient adults who did not receive GH replacement .  Design and Setting : This was a prospect i ve observational study in the setting of US clinical practice s. Patients and Outcome Measures : AEs were compared between GH-treated ( n = 1988 ) and untreated ( n = 442 ) GH-deficient adults after adjusting for baseline group differences and controlling the false discovery rate . The st and ardized mortality ratio was calculated using US mortality rates . Results : After a mean follow-up of 2.3 years , there was no significant difference in rates of death , cancer , intracranial tumor growth or recurrence , diabetes , or cardiovascular events in GH-treated compared with untreated patients . The st and ardized mortality ratio was not increased in either group . Unexpected AEs ( GH-treated vs untreated , P ≤ .05 ) included insomnia ( 6.4 % vs 2.7 % ) , dyspnea ( 4.2 % vs 2.0 % ) , anxiety ( 3.4 % vs 0.9 % ) , sleep apnea ( 3.3 % vs 0.9 % ) , and decreased libido ( 2.1 % vs 0.2 % ) . Some of these AEs were related to baseline risk factors ( including obesity and cardiopulmonary disease ) , higher GH dose , or concomitant GH side effects . Conclusions : In GH-deficient adults , there was no evidence for a GH treatment effect on death , cancer , intracranial tumor recurrence , diabetes , or cardiovascular events , although the follow-up period was of insufficient duration to be conclusive for these long-term events . The identification of unexpected GH-related AEs reinforces the fact that patient selection and GH dose titration are important to ensure safety of adult GH replacement
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 .