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 .
The effect of low dose recombinant human growth hormone replacement on regional fat distribution, insulin sensitivity, and cardiovascular risk factors in hypopituitary adults.
GH deficiency is associated with increased cardiovascular morbidity , which may be determined by alterations in vascular risk factors . We report the effect of partially treated hypopituitarism and subsequent GH replacement ( mean dose , 0.2 IU/kg.week ) on putative cardiovascular risk factors in 22 nondiabetic hypopituitary subjects in a 6-month , double blind , controlled study ( active/placebo ratio , 11:11 ) . All patients were subsequently treated with GH for a further 6 months .  Total fat , percent body fat , and central fat were measured by dual energy x-ray absorptiometry .  The hypopituitary patients had increased percent fat ( P = 0.03 ) and central fat ( P < 0.01 ) compared with body mass index-matched controls . Before GH treatment , fasting ( total ) and specific insulin positively correlated with body mass index ( P = 0.02 and P < 0.001 , respectively ) , waist/hip ratio ( P = 0.05 and P = 0.01 ) , and central fat ( P = 0.03 and P = 0.003 ) . Specific insulin and insulin sensitivity ( IS ) , calculated by homeostatic model of assessment , were related to total fat ( P < 0.001 and P = 0.02 ) . GH treatment for 6 months led to a reduction in total fat ( P < 0.02 ) , percent fat ( P = 0.002 ) , central fat ( P = 0.012 ) , waist/hip ratio ( P < 0.05 ) , total cholesterol ( P = 0.03 ) , and apolipoprotein-B ( P = 00001 ) , as well as a decrease in the IS from 36.9 % ( range , 12 - 100 % ) to 25 % ( range , 2.5 - 55 % ; P = 0.0002 ) . This was paralleled by a rise in fasting ( total ) and specific insulin ( P = 0.016 and P = 0.002 ) . The degree of correlation among indices of IS , body composition , and fat distribution increased after GH treatment . Fasting plasma glucose rose significantly , but was within the reference range . During 12 months of GH therapy , a significant increase in serum lipoprotein-(a ) was observed ( P < 0.05 ) . Although GH has beneficial effects on central adiposity and lipid fractions , it is also associated with a decrease in IS ; these effects may vary between individuals
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 .