How are the different hormonal treatments monitored?
Monitoring central adrenal insufficiency and central hypothyroidism is not as clear-cut as monitoring their primary counterparts.
• ACTH deficiency: Because there is no reliable marker to determine exact glucocorticoid requirements, dose adjustments depend on clinical status, comorbid conditions, and the patient’s sense of well-being.
• TSH deficiency: Serum TSH levels cannot be used to adjust thyroid replacement dosing in patients with central hypothyroidism. Serum free T 4 , obtained before the LT 4 dose, should be used instead. The target free T 4 level should be in the mid- to upper half of the reference range.
• Gonadotropin deficiency:
• Testosterone replacement therapy is monitored with serum testosterone levels. In patients on testosterone injections, the testosterone level should be obtained half-way between shots. In those on topical testosterone, it should be obtained 4 to 12 hours after its application. Hematocrit and hemoglobin should be obtained twice a year to rule out polycythemia.
• In women on estrogen/progesterone replacement, follow-up includes assessing symptoms and monitoring for side effects. Measuring serum estradiol is not beneficial.
• GH deficiency: GH doses should be titrated by 0.1 to 0.2 mg per day at 6-week intervals, targeting age-adjusted IGF-1 levels in the midnormal range. Once this target is achieved, IGF-1 should be measured every 6 months. If side effects occur, the dose should be reduced. Younger patients, those who are morbidly obese, and women, mainly if taking oral estrogens, usually require higher starting and maintenance doses of GH.
