Aspects of Growth Hormone (GH) Replacement in Elderly Patients with GH Deficiency: Data from KIMS

Abstract

This study was designed to examine the clinical characteristics of adult-onset growth hormone deficiency (AO-GHD) in patients aged over 65 years in comparison with patients aged less than 65 years. In addition, the effects of 12 months of GH replacement therapy on body composition, carbohydrate metabolism, blood pressure, serum lipids and quality of life were compared between patients aged over 65 years and patients under 45 years, 45–55 years and 55–65 years of age. The investigation was an observational study of patients enrolled in KIMS (Pharmacia International Metabolic Database). Baseline clinical characteristics were qualitatively similar, and scores from the Assessment of Quality of Life in GH-deficient Adults questionnaire (QoL-AGHDA) were indistinguishable between patients aged over 65 years and younger patients. Improvements in QoL-AGHDA scores were similar in all age groups during GH replacement therapy. Significant reductions in total and low-density lipoprotein cholesterol levels were observed in all groups and tended to be greater in patients aged over 65 years. Waist circumference and waist:hip ratio were not influenced by GH replacement therapy in women aged over 65 years, which was in contrast to the reductions observed in younger male and female patients and the decrease in waist circumference observed in men aged over 65 years. The similarities and differences in response to GH replacement therapy between patients aged over 65 years and those aged less than 65 years remained evident when the latter group was stratified by age. In conclusion, older patients with AO-GHD who receive GH replacement therapy achieve beneficial effects equivalent to those seen in younger patients in all age groups and require lower doses of GH.

Adult GH deficiency throughout lifetime

“…When middleaged and elderly GHD patients enrolled in the KIMS database were compared (mean age 47.9 vs 69.1 years), there was no difference in mean baseline BMI and waistto-hip ratio (WHR) in men (Table 1), but BMI and WHR were higher in older women than younger women (BMI 29.9 vs 28.2 kg/m 2 , P!0.02; WHR 0.90 vs 0.86, P!0.01; Table 2) (36). In this analysis, both men and women in each age category demonstrated an improvement in WHR with 1 year GH replacement (36).…”

“…When middleaged and elderly GHD patients enrolled in the KIMS database were compared (mean age 47.9 vs 69.1 years), there was no difference in mean baseline BMI and waistto-hip ratio (WHR) in men (Table 1), but BMI and WHR were higher in older women than younger women (BMI 29.9 vs 28.2 kg/m 2 , P!0.02; WHR 0.90 vs 0.86, P!0.01; Table 2) (36). In this analysis, both men and women in each age category demonstrated an improvement in WHR with 1 year GH replacement (36). An analysis of different aged patients enrolled in HypoCCS confirmed this finding, with older GHD patients (O60 years old) having a more pronounced decrease in WHR after 3 years GH treatment than younger patients, despite having no significant improvement in LBM (37).…”

“…GH replacement is usually associated with a neutral effect on blood pressure (BP) (38); the antinatriuretic and possible chronotropic actions of GH are offset by vasodilation arising from increased generation of endothelial nitrous oxide. In studies where changes have been reported, these tend to reflect improvements in diastolic BP (27,36,39,51). These findings may be less apparent in older patients.…”

“…Poor baseline QoL-AGHDA score predicts a greater psychosocial response to GH replacement (65). There seems to be no difference in improvement in QoL in adult patients of different ages, with older patients deriving as much benefit from GH replacement as those who are younger (27,36,39) (Fig. 4).…”

Assessment of quality of life in adult patients with GH deficiency: KIMS contribution to clinical practice and pharmacoeconomic evaluations

“…Some of them indicate no difference between the age groups (36,46,53), others suggest better QoL in younger patients (38,48). Nevertheless, the first observation of Bengtsson et al (45) that age has no impact on beneficial effects of GH therapy was confirmed by Monson et al in the studies (46,53) comparing patients with AO-GHD aged below and above 65 years as well as in the recent analysis of response to treatment based on utilities (38).…”