Besides micropenis in males, additional consequences of severe deficiency in the first days of life can include hypoglycemia and exaggerated jaundice (both direct and indirect hyperbilirubinemia).
[citation needed] Severe GH deficiency in early childhood also results in slower muscular development, so that gross motor milestones such as standing, walking, and jumping may be delayed.
Some severely GH-deficient children have recognizable, cherubic facial features characterized by maxillary hypoplasia and forehead prominence.
[5] Other side effects in children include sparse hair growth and frontal recession, and pili torti and trichorrhexis nodosa are also sometimes present.
[15] GH does function in adulthood to maintain muscle and bone mass and strength, and has poorly understood effects on cognition and mood.
Physicians, therefore use a combination of indirect and direct criteria in assessing GHD, including:[17] "Provocative tests" involve giving a dose of an agent that will normally provoke a pituitary to release a burst of growth hormone.
An intravenous line is established, the agent is given, and small amounts of blood are drawn at 15-minute intervals over the next hour to determine if a rise of GH was provoked.
Agents which have been used clinically to stimulate and assess GH secretion are arginine,[18] levodopa, clonidine, epinephrine and propranolol, glucagon, and insulin.
In both children and adults, costs of treatment in terms of money, effort, and the impact on day-to-day life, are substantial.
[22] GH treatment is not recommended for children who are not growing despite having normal levels of growth hormone, and in the UK it is not licensed for this use.
Most pediatric endocrinologists monitor growth and adjust dose every 3–6 months and many of these visits involve blood tests and x-rays.
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.
[26] GH treatment can confer a number of measurable benefits to severely GH-deficient adults, such as enhanced energy and strength, and improved bone density.
[25] Effects on quality of life are unproven, with a number of studies finding that adults with GHD had near-normal indicators of QoL at baseline (giving little scope for improvement), and many using outdated dosing strategies.
[28] Notable modern pop cultural figures with growth hormone deficiency include actor and comedian Andy Milonakis, who has the appearance and voice of an adolescent boy despite being in his 40s.
[29][30] Argentine footballer Lionel Messi was diagnosed at age 10 with growth hormone deficiency and was subsequently treated.
[31] TLC reality star Shauna Rae was affected by a medically-caused growth hormone deficiency resulting from childhood glioblastoma cancer treatment.