RhGh did not consistently affect blood pressure or bone mineral density .
RhGH consistently improved quality of life ( QoL ) parameters reflected in AGHDA-scores .
Conclusion RhGH replacement in elderly subjects with GHD  decreases LDL cholesterol levels and improves QoL , but the effects on other parameters are not unequivocal .
There were no data on the efficacy and safety  of rhGH treatment in octogenarians with GHD
Context Recombinant human GH ( rhGH ) is prescribed for the treatment of adults with GH deficiency ( GHD ) .
However , conflicting data are available on the efficacy of rhGH treatment in elderly GHD patients .
Objective To assess the efficacy of rhGH treatment in elderly GHD subjects .
Optimizing growth hormone replacement therapy by dose titration in hypopituitary adults.
Although growth hormone ( GH ) replacement therapy is increasingly utilized in the management of adult hypopituitary patients , optimum dosing schedules are poorly defined . The use of weight-based or surface area-based dosing may result in overtreatment , and individual variation in susceptibility on the basis of gender and other factors is now being recognized . To optimize GH replacement and to explore further gender differences in susceptibility , we used a dose titration regimen , starting at the initiation of GH replacement therapy , in 50 consecutive adult-onset hypopituitary patients , and compared the results with those in 21 patients previously treated using a weight-based regimen . Titrated patients commenced GH 0.8 IU/day subcutaneously ( 0.4 IU/day if hypertensive or glucose tolerance impaired ) . Serum insulin-like growth factor I ( IGF-I ) was measured at 0 , 2 , 4 , 6 , 8 , 10 , and 12 weeks in all patients . Serum IGF binding protein 3 and acid labile subunit were measured at the same time points in 17 patients ( 8 male , 9 female ) . Patients were review ed every 4 weeks and the dose of GH increased , if necessary , to achieve a serum IGF-I level between the median and the upper end of the age-related reference range . There was no significant difference between mean serum IGF-I at 2 and 4 weeks , or between 6 and 8 weeks , indicating that the full effects of a change in dose are evident within 2 weeks of that change . Maintenance doses were significantly higher in females than males [ 1.2 ( 0.8 - 2.0 ) vs. 0.8 ( 0.4 - 1.6 ) IU/day ; median ( range ) ; P < 0.0001 ] , and the median time to achieve maintenance dose was significantly shorter in males [ 4 ( 2 - 12 ) vs. 9 ( 2 - 26 ) weeks ; P < 0.0001 ] . Median maintenance dose was lower overall than in a group of 21 patients initially commenced on GH using a weight-based dosing schedule , with subsequent adjustment of dose during clinical follow-up [ 1.5 ( 0.4 - 3.2 ) IU/day ; P = 0.02 ] . Reduction in waist measurement and waist to hip ratio at 6 and 12 months was similar in females ( P < 0.001 ) and males ( P < 0.01 ) . Well-being improved significantly after 3 months of GH therapy ( 14.2 + /- 5.9 vs. 7.4 + /- 4.5 SD ; P < 0.0001 ) , and there were no gender differences . Adult Growth Hormone Deficiency Assessment ( AGHDA ) scores at 6 months were similar to maintenance scores in patients commenced on weight-based regimens . Measurements of ALS and IGFBP-3 added no useful extra information to IGF-I in managing the dose titration . The practical scheme outlined for dose titration of GH replacement result ed in rapid achievement of lower maintenance doses than those achieved using conventional weight-based regimens without loss of efficacy . It was particularly important in female patients who demonstrated decreased overall sensitivity to GH  and required higher doses to achieve the same effects as males . This constitutes the first report of a uniform titration regimen based on a defined target range of serum IGF-I in a large patient cohort
RhGh did not consistently affect blood pressure or bone mineral density .
RhGH consistently improved quality of life ( QoL ) parameters reflected in AGHDA-scores .
Conclusion RhGH replacement in elderly subjects with GHD  decreases LDL cholesterol levels and improves QoL , but the effects on other parameters are not unequivocal .
There were no data on the efficacy and safety  of rhGH treatment in octogenarians with GHD
Context Recombinant human GH ( rhGH ) is prescribed for the treatment of adults with GH deficiency ( GHD ) .
However , conflicting data are available on the efficacy of rhGH treatment in elderly GHD patients .
Objective To assess the efficacy of rhGH treatment in elderly GHD subjects .