Strategies for appraising suspected growth hormone deficiency in the adult

As North American and European colleagues, we here examine more critically the validity of available methods to diagnose adult growth hormone (GH) deficiency, selected pitfalls therein, ancillary measures to aid in decision-making and associated clinical confounders. Given the range of such issues, we believe that the evaluation and treatment of GH deficiency associated with pituitary disease remains largely the responsibility of endocrinologists, rather than primary care practitioners. We hope that the joint cis- and trans-Atlantic perspectives will ensure a relatively balanced representation of issues recognized by the respective clinical communities and drug regulatory agencies.