The risks of replacement therapy with hGH in GH-deficient adults varied with pathogenesis of disease; hGH-related adverse events occurred more frequently in patients with adult-onset compared with those childhood-onset GH deficiency. In the adult-onset patients there was an increased risk of adverse events in heavier patients and those who had the greatest increases in IGF-I and IGFBP-3 at 1 month of therapy.

Objective: The aim of the present study was to assess the socio-economic impact at baseline and after one year of follow-up of clinical and health status characteristics and laboratory tests of adult-onset GH deficiency (AGHD), a well-known clinical entity, in a large group of Spanish hypopituitary patients with untreated AGHD. Design and Methods: A total of 926 eligible patients with GHD (GH Յ 5 ng/ml after stimulation) and at least one further pituitary hormone deficiency were retrospectively studied; 356 of these were followed for one year. Complete physical examination, IGF-I, lipid and routine biochemistry measurements and health-related quality of life (HRQoL) with the specific QoL-Assessment of Growth Hormone Deficiency in Adults (AGHDA) questionnaire were assessed at baseline and at 12 months in the prospective study. Health status and health-economic evaluation were measured by a specific questionnaire and a patient diary and compared with Spanish population study results. Results: Clinical characteristics and laboratory tests of AGHD showed a higher incidence of cardiovascular risk factors and mortality compared with the general population (hypercholesterolaemia in 29% vs 18% and hypertension in 22.1% vs 14.9%). QoL-AGHDA scores for patients were significantly worse (P<0.01) and direct health costs were higher than in the general population. Conclusions: Hypopituitary GHD adults had more cardiovascular risk factors, higher mortality, worse HRQoL and higher absolute health costs than the general population in Spain.

• ▶ body composition • ▶ Cushing ' s syndrome • ▶ rheumatoid arthritis • ▶ glucocorticoids Body Composition After Endogenous (Cushing ' s Syndrome) and Exogenous (Rheumatoid Arthritis) Exposure to Glucocorticoids abolition of the normal male to female diff erence in visceral fat [5]. It has been assumed that resolution of hypercortisolism is followed by normalization of body composition; a decrease in fat mass has been reported in the early recovery after successful treatment of CS [6, 7]. However, patients who have suff ered from CS, often complain of central obesity, despite successful treatment, which may even have rendered them adrenal insuffi cient. Persistence of increased cardiovascular risk and carotid atherosclerosis has been reported in patients with CS after fi ve years of cure [8]. Moreover, there could be a relationship between cortisol and fasting glucose [9]. Rheumatoid arthritis (RA) is a chronic, systemic infl ammatory disorder that may aff ect many tissues and organs, but principally attacks the joints producing an infl ammatory synovitis that often progresses to destruction of the articular carti