Question: I had two unsuccessful transsphenoidal surgeries followed by radiation. Since my ACTH levels were still extremely elevated, I had a bilateral adrenalectomy. My physical appearance (weight and fat distribution) has not changed as much as my doctor expected. Would growth hormone therapy be useful in my case?

Answer: The lack of change in your physical appearance may be related to excessive hydrocortisone replacement. Over the past few years, it has become increasingly evident that many patients with adrenal insufficiency (no adrenal function) do not require as much hydrocortisone therapy as previously thought. In the past, many patients were treated with as much as 25-30 mg of hydrocortisone daily in divided doses; however, some patients really need no more than 10-15 mg daily. Patients without adrenal function should also be treated with Florinef. Your hydrocortisone replacement dose should be titrated down to as low a level as you can tolerate.

Growth hormone is now available for treatment of adult patients with hypopituitarism. Growth hormone therapy has been shown to decrease body fat as well as increase lean muscle mass in adult patients with hypopituitarism. Patients treated with growth hormone have also reported increased energy level and a better sense of well being; however, long term studies with growth hormone in adult patients have not been performed and some endocrinologists have questions about its possible side effects when taken for several years. In addition, growth hormone is very expensive and persuading insurance companies or HMO's to pay for this may be difficult.