Quality of life assessment before and after growth hormone treatment in adults with growth hormone deficiency. Acta Paediatr Scand [Suppl] 356: 70, 1989. The effect of recombinant human growth hormone (rhGH) treatment on the quality of life w'as studied in adults with growth hormone deficiency (GHD). Twenty-four adults who satisfied strict criteria for GHD took part in a double-blind, placebo-controlled, 6-month trial. 'Quality of life' assessment was performed at entry into the trial and after 1 month and 6 months, by means of self-rating questionnaires. Entry data were also compared with a control group of healthy subjects matched for age, gender, ethnic origin, socio-economic class and area of residence. Significantly lower scores on 'quality of life' assessment in the growth hormone (GH) deficient patients were reported at entry into the trial compared with matched controls, indicating that patients with GHD may be psychologically compromised. Preliminary analysis of the results shows that after 6 months patients receiving human growth hormone (hGH) treatment experienced less perceived illness than the placebo group. Significant psychological improvement was noted in the hGH-treated patients' perception of their energy level and mood compared to the placebo group. Key words: Qua& of life, psychological well-being, growth hormone deficiency.The personality and social development of children with hypopituitary short stature due to impaired growth hormone (GH) secretion, and their psychological response to GH replacement therapy have been previously documented (1, 2). Children with GHD were found to be psychologically immature and showed a diffuse disturbance of personality formation. In their long-term follow-up studies of adults previously treated with hGH in childhood, Dean et al. and Job et al. measured the educational, marital and employment status in order to discuss social outcome and psychological integration (3, 4). Their results showed that patients with GHD were more likely to be single and unemployed.Little work has been published on the psychological status of GH deficient adults and the effect of hGH replacement therapy on their general well-being and quality of life. PATIENTS AND METHODSSubject selection and characteristics. Patients were selected for the study if they satisfied the following criteria: age between 18 and 55 years; GH deficient for at least 12 months; if pituitary hormone replacement had been required, the treatment regimen should have been stable for 12 months before entry into the study. GHD was defined as a GH concentration of < 3mUil during an insulin tolerance test, with a venous plasma glucose concentration of I 2.0 mmolil and/or associated with symptoms of hypoglycaemia. The mean known duration of GHD was 8 years. The majority of the patients acquired GHD in adulthood as a consequence of pituitary tumours and/or pituitary surgery. All patients were on pituitary replacement therapy. In addition, a group of control subjects for baseline comparison were matched for age, gend...

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The effect of recombinant-DNA human growth hormone treatment on psychological well-being and quality of life was studied in adults with GH deficiency (GHD). 24 adults who satisfied strict criteria for GHD took part in a double-blind, placebo-controlled, 6-month trial. Quality of life assessments were performed at entry, 1 and 6 months by means of self-rating questionnaires. This study reports significantly lower scores on quality of life assessment in the GH-deficient patients at entry compared with matched controls, indicating that this population may be psychologically compromised. Preliminary analysis of treatment results shows that after 6 months, those patients receiving active treatment experienced less perceived illness than the placebo group. Significant psychological improvements were noted in the patients’ perception of their energy level and mood.

There is limited evidence that siblings of stillborn infants are more vulnerable to psychological problems. This case-controlled study examines the relationship between previous stillbirth and the next child's pattern of attachment and explores factors in the mother which may be associated with and which may explain the pattern of infant attachment. We examined 53 infants next-born after a stillbirth, and 53 control infants of primigravid mothers. Maternal demographic, psychiatric, and attachment data were collected in pregnancy, and self-report measures of depression collected in the first year. Infant attachment patterns to the mothers were assessed when the infants were 12 months old using the Ainsworth Strange Situation Procedure. Infants next-born after stillbirth showed significant increase in disorganisation of attachment to the mother compared with control infants (p < .04). The difference was not accounted for by differences in psychiatric symptoms or demography. It was strongly predicted by maternal unresolved status with respect to loss as measured in the Adult Attachment Interview, and less strongly by maternal experience of elective termination of pregnancy and by the mother having seen her stillborn infant. The study adds weight to previously reported clinical observations, that infants born after stillbirth may be at risk of an increase in psychological and behavioural problems in later childhood. The strong association between disorganisation of infant attachment and maternal state of mind with respect to loss suggests that the mother's state of mind may be causal, and raises interesting questions about the mechanism of intergenerational transmission. Given the existing evidence of later developmental problems, longer-term follow-up of these children would be valuable.