DR. HOOK- Belly flop: When hormone shortage means greater girth

I've always been the shortest guy– in school, among my friends, among my colleagues. In my medical school class picture, I'm standing in the front. No one wants to play volleyball with me because I can't spike the ball. I have to have all my pants altered because no one makes 29/29 pants. Everything in Charlottesville now starts at 32/32– it's a conspiracy!

 I say I'm superior because I'm more ecologically efficient. I breathe less air, eat less food, and take up less space (though some say I give out more hot air). But I don't have growth hormone (GH) deficiency; I'm short because of genetics.  

For adults who acquire GH deficiency, it's an oxymoron because they do grow– sideways, that is. GH is produced in the pituitary gland. My medical school mentor and world-renown pituitary expert Dr. Mary Lee Vance used to say, "Repeat after me, ‘The pituitary gland is smarter than the doctor.'"  

And you know what? She's right– just as her shoes are incredibly fashionable.  

The pituitary gland sits in the brain kind of between your eyes but further back. It releases various hormones to control all the other glands in the body. If something happens to the pituitary gland, GH is often cut short– no pun intended.

But adults don't become shorter with GH deficiency. They become fatter, in particular in the belly. 

Now, hold your horses, folks! I know about two-thirds of you have large bellies since that's our current obesity situation. I'm sure many of you are saying, "Hallelujah! I'm going to see my doctor and get me some growth hormone! That way I don't have to exercise or eat right, and I'll look like Kate Moss!" Sorry, Charlie. Most people who are obese don't have GH deficiency; they have exercise deficiency.

In addition to decreased muscle mass and increased body fat, GH deficiency can lead to a weak heart– something the Tin Man would never appreciate. The heart doesn't pump as well with GH deficiency, and the coronary arteries can get clogged up with cholesterol plaques. People with GH deficiency tend to have less energy as well as a general unhealthy feeling– which is why growth hormone has been toted by the elderly as the "fountain of youth."

But GH is not the fountain of youth. We've heard allegations of world class athletes abusing GH to increase muscle and heart function– but it also can lead to an abnormally enlarged heart– and death. Also, if someone has cancer, growth hormone can make the cancer grow even faster.

But in those who have true adult GH deficiency, recombinant growth hormone is available through an endocrinologist. My partner in medicine as well as in life, Dr. Chris Zitnay, who's an endocrinologist, seems to have a dozen different recombinant growth hormones available– which I don't understand because isn't an iPOD and iPOD? Don't you just need one really good one? All of them seem pretty good to me.

A blood test to show low IGF-1 is associated with GH deficiency. An arginine stimulation test or insulin-induced hypoglycemia test can be done to confirm diagnosis. Many health insurances make you do the test twice just to confirm the diagnosis, though I think what they're actually doing is seeing if you're a world class athlete who wants big muscles.

We all grow in one way or another. Life is ever changing. But I think it is best to expand your mind, not your belly, especially if you lack GH.