From the Research
The IGF-1 level of 93 with a z-score of -8, along with DHEA of 394 and DHEAS of 100 in a 52-year-old female with a pituitary adenoma, are not normal values, indicating a high likelihood of growth hormone deficiency, which requires comprehensive evaluation and potential replacement therapy to improve quality of life. The severely low IGF-1 level, as indicated by the -8 z-score, strongly suggests growth hormone deficiency, a common condition in patients with pituitary adenomas due to compression of normal pituitary tissue 1.
Clinical Implications
The DHEA and DHEAS levels appear to be within normal ranges for a woman of this age, though interpretation depends on the specific laboratory reference ranges. This patient should be evaluated by an endocrinologist for comprehensive pituitary function testing, including assessment of other hormonal axes (thyroid, adrenal, gonadal) 2.
Diagnostic Approach
If growth hormone deficiency is confirmed, growth hormone replacement therapy might be recommended, typically starting at 0.1-0.3 mg daily and titrating based on IGF-1 levels and symptom response 3. Regular monitoring of the pituitary adenoma with MRI imaging is also essential, along with visual field testing if the adenoma is near the optic chiasm.
Treatment Considerations
Growth hormone replacement can improve quality of life by addressing symptoms like fatigue, decreased muscle mass, increased fat mass, and reduced exercise capacity in adults with growth hormone deficiency 4. It is crucial to consider the potential for GH deficiency even in patients with normal serum IGF-1 levels, as the prevalence of GH deficiency in adults with nonsecreting pituitary microadenomas can be significant 2.
Key Points
- The patient's severely low IGF-1 level suggests growth hormone deficiency.
- Comprehensive pituitary function testing is necessary.
- Growth hormone replacement therapy may be recommended if deficiency is confirmed.
- Regular monitoring of the pituitary adenoma and potential effects on other hormonal axes is essential.