GH supplementation is not recommended medically for the physiologic age-related decline in GH/IGF secretion.[6][9] It may be appropriate in diagnosed adult-onset deficiency, where a weekly dose approximately 25% of that given to children is given. Lower doses again are called for in the elderly to reduce the incidence of side effects and maintain age-dependent normal levels of IGF-1.[12]In many countries, including the UK, the majority view among endocrinologists is that the failure of treatment to provide any demonstrable, measurable benefits in terms of outcomes means treatment is not recommended for all adults with severe GHD,[4] and national guidelines in the UK as set out by NICE suggest three criteria which all need to be met for treatment to be indicated:Severe GH deficiency, defined as a peak GH response of <9mU/litre during an insulin tolerance testPerceived impairment of quality of life, as assessed by questionnaireThey are already treated for other pituitary hormone disordersWhere treatment is indicated, duration is dependent upon indication.Cost of adult treatment in the UK is 3000-4000 GBP annually.[4]
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