Effects of discontinuation of growth hormone replacement in adult GH-deficient patients: a cohort study and a systematic review of the literature

Appelman‐Dijkstra, Natasha M.; Rijndorp, Marnick; Biermasz, Nienke R.; Dekkers, Olaf M.; Pereira, Alberto M.

doi:10.1530/eje-15-1086

Cited by 10 publications

(9 citation statements)

References 50 publications

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“…A greater QoL improvement was observed in those who were not depressed, lived in Europe (as compared to the US), had poorer initial Z-scores (i.e., worse QoL), had a lower body mass index (BMI) at entry, and had no impaired vision (19). If GH treatment is discontinued for several months, emotional reactions, well-being and tiredness worsen, especially in younger patients, all of which may negatively affect QoL (23,24).…”

Section: Hypopituitarism (Including Growth Hormone Deficiency)mentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Quality of life tools for the management of pituitary disease

Webb

Crespo

Santos

et al. 2017

European Journal of Endocrinology

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Background: In the last few years, quality of life (QoL) has become an outcome measure in patients with pituitary diseases. Objective: To describe the available data on QoL impairment evaluated with questionnaires in patients with pituitary diseases. Design: Critical review of the pertinent literature and pragmatic discussion of available information. Methods: Selection of relevant literature from PubMed and WOK, especially from the last 5 years and comprehensive analysis. Results: QoL is impaired in all pituitary diseases, mostly in acromegaly and Cushing's disease (similar to other causes of Cushing's syndrome), but also in non-functioning pituitary adenomas and prolactinomas, especially in the active phase of the disease. Nevertheless, even after endocrine 'cure', scores tend to be below normative values, indicative of residual morbidity after hormonal control. The presence of hypopituitarism worsens subjective QoL perception, which can improve after optimal substitution therapy, including recombinant human growth hormone, when indicated. Conclusions: To improve the long-term outcome of pituitary patients, helping them to attain the best possible health, it appears desirable to include subjective aspects captured when evaluating QoL, so that the affected dimensions are identified and if relevant treated. Additionally, being aware that treatment outcome may not always mean complete normalisation of physical and mental issues related to QoL can be a first step to adaptation and conforming to this new status.

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Section: Hypopituitarism (Including Growth Hormone Deficiency)mentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Quality of life tools for the management of pituitary disease

Webb

Crespo

Santos

et al. 2017

European Journal of Endocrinology

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“…In addition, although treatment with GH was accompanied by an increase in lean body mass, most studies do not allow differentiation between extracellular water and intracellular mass. Therefore, the lean body mass data may not be accurate as GH replacement is associated with an increase in the intracellular water component . However, GH replacement therapy increases muscle strength and exercise capacity in patients with GH deficiency.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, the lean body mass data may not be accurate as GH replacement is associated with an increase in the intracellular water component. 11,29 However, GH replacement therapy increases muscle strength and exercise capacity in patients with GH deficiency. This might indirectly suggest an actual increase in muscle mass.…”

Section: Discussionmentioning

confidence: 99%

“…Initial studies found that treatment with GH induced a decrease in fat mass and an increase in lean mass . However, a recent systematic review reported that the long‐term effects on body mass index seem to be inconclusive, with some studies reporting an increase and other reporting no change . The clinical response to GH therapy is highly variable among patients with AGHD and is influenced by sex, age, body mass index (BMI) and GH dose .…”

Section: Introductionmentioning

confidence: 99%

“…10 However, a recent systematic review reported that the long-term effects on body mass index seem to be inconclusive, with some studies reporting an increase and other reporting no change. 11 The clinical response to GH therapy is highly variable among patients with AGHD and is influenced by sex, age, body mass index (BMI) and GH dose. 12 A randomized and placebo-controlled study 7 found that GH treatment significantly improved body composition in a dose-responsive manner.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of low lean mass in patients with adult growth hormone deficiency with or without low‐dose growth hormone therapy

Zheng

Cheng

Jiang

et al. 2019

Clinical Endocrinology

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Summary Objective The importance of muscle mass has been emphasized in various studies, and growth hormone (GH) deficiency is tightly associated with lean mass loss. Therefore, we aimed to investigate the prevalence of low lean mass in patients with adult growth hormone deficiency (AGHD) who received or did not receive GH therapy. Methods In this retrospective study, we included patients diagnosed with AGHD by using the insulin tolerance test (ITT) in our hospital. Patients without completed follow‐up data were excluded, and data for 56 patients were analysed. Twenty‐six patients who had received GH therapy for more than 6 months, based on the medical record, were included in the GH group and received recombinant human growth hormone (rhGH) at a dose of 0.5 IU/d. Thirty patients who had not previously received GH treatment were included in the non‐GH group. Many anthropometric and blood biochemical indicators were measured. Body composition was measured on a dual‐energy X‐ray‐absorptiometry (DXA) scanner. Low lean mass was defined as a skeletal muscle index (SMI) <7.0 kg/m2 in males or 5.7 kg/m2 in females. Statistical analyses were performed using GraphPad Prism 5.0. Results Compared to the non‐GH group, the patients who received GH therapy had significantly lower total cholesterol (TC), low‐density lipoprotein cholesterol (LDL‐c) and fasting plasma glucose (FPG). The percentage of patients with low lean mass in GH and non‐GH groups was 30.77% and 60%, respectively. The percentage of total lean was lower in the GH group than in the non‐GH group, but the difference in total lean mass was not statistically significant. Conversely, patients with GH treatment had significantly lower fat mass and percentage than non–GH‐treated patients (P < 0.05). The GH group had significantly higher serum levels of both IGF‐1 and IGFBP3. Moreover, both IGF‐1 and IGFBP3 were significantly correlated with SMI (r2 = 0.275, P = 0.003, and r2 = 0.138, P = 0.005, respectively). Conclusions Our data showed that AGHD patients who received low‐dose GH treatment had a lower prevalence of low lean mass than those who did not receive GH treatment. Patients with GH treatment had significantly lower cardiovascular risk factors, especially the lipid profile.

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Treatment of adult growth hormone deficiency with human recombinant growth hormone: an update on current evidence and critical review of advantages and pitfalls

Ramos-Leví

Marazuela

2018

Endocrine

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Adult-onset growth-hormone (GH) deficiency (GHD) is a rare disorder, which most commonly results from pituitary or peripituitary tumors and their treatment, and is characterized by alterations in body composition, carbohydrate and lipid metabolism, bone mineral density, cardiovascular risk profile and quality of life, all of which may contribute to an increased morbidity and mortality. Since recombinant human GH (rhGH) became available in 1985, several studies have provided evidence of its beneficial effects, despite the potential risk of developing adverse effects, and much clinical experience has been accumulated. However, in adults, the precise therapeutic role of GH replacement therapy and the individual response to it remains highly variable and is still a matter of debate. In this article, we present a critical review of the available evidence on rhGH replacement therapy in GHD adults, emphasizing the pitfalls clinicians encounter in the diagnosis of GHD and monitoring of rhGH replacement therapy. We will cover all the relevant aspects regarding the potential usefulness of GH treatment, including the hot topic of mortality.

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Effects of discontinuation of growth hormone replacement in adult GH-deficient patients: a cohort study and a systematic review of the literature

Cited by 10 publications

References 50 publications

MANAGEMENT OF ENDOCRINE DISEASE: Quality of life tools for the management of pituitary disease

MANAGEMENT OF ENDOCRINE DISEASE: Quality of life tools for the management of pituitary disease

Prevalence of low lean mass in patients with adult growth hormone deficiency with or without low‐dose growth hormone therapy

Treatment of adult growth hormone deficiency with human recombinant growth hormone: an update on current evidence and critical review of advantages and pitfalls

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