Management of glucocorticoid replacement in adult growth hormone deficiency

In multiple pituitary hormone deficiency, interactions occur among thyroxine, cortisol and growth hormone (GH). This review addresses the issues of endogenous cortisol production and exogenous cortisol replacement and discusses cortisol metabolism in the context of adult GH deficiency. In addition, we review the effect of GH on 11-beta-hydroxysteroid dehydrogenase type 1, the current literature regarding the choice of glucocorticoid ( GC) treatment and dose levels and dosing regimens. Recommendations for GC replacement therapy are also provided. Copyright (c) 2007 S. Karger AG, Basel.