GH deficiency in adults: an epidemiological approach

Abstract

Objective: The prevalence of adult onset GH deficiency (GH-D) is poorly documented. Epidemiological data are now required to estimate the financial cost of GH treatment in adults. The aim of the present study was to estimate the prevalence of GH-D, from a cohort of 1652 adult patients with hypothalamo-pituitary diseases. Design: The hormonal status of all patients presenting with pituitary disease and observed during the year 1994 in 15 endocrine units was retrospectively analyzed, irrespective of the date of disease onset, of the nature and date of pituitary investigations, and whether or not they included specific testing of the GH axis. Of the whole population of 1652 patients, a selected group (RG2) was chosen after exclusion of patients with active acromegaly (n = 1414). Results: GH stimulation tests had been performed in 549 patients of the RG2 group and a documented GH-D was found in 301. A relationship between the value of the GH peak and the number of pituitary deficits was evaluated. For instance, it was shown that 93% of patients with three deficits had GH-D. These results constituted the basis for estimating the number of GH-D in the group of untested patients. The number of GH-D deduced from the number of established GH-D (n = 301) and from the number of GH-D hypothesized from other pituitary deficits (n = 406) was 707 cases. Prevalence and annual incidence were calculated from data recorded in a referral center with a well-defined catchment area, Marseilles (Bouches du Rhône department). We projected a prevalence of 2638 for France and an annual incidence of 12 GH-D per million of the adult population.

Incidence of GH deficiency – a nationwide study

“…An increased clinical awareness is a possible contributing cause for this increase in incidence. The finding of an average incidence rate of 1.65 per 100 000 for AO GHD is higher than, but in agreement with, the finding of 1.2 per 100 000 in a French study (6), and the estimate of 1.0 per 100 000 from The Growth Hormone Research Society (12). The denominator in the latter study was not specified, and it is thus not clear whether the estimate is age-specific or based on the total population.…”

“…4 Neoplasm of uncertain or unknown behavior of the crainopharyngeal duct DE23.0 Hypopituitarism DE23.1 Drug-induced hypopituitarism DE23. 6 Other disorders of the pituitary gland DE23. 7 Other disorders of the pituitary gland, unspecified DE34.…”

“…Childhood onset (CO) GHD has been estimated to occur in 1 per 30 000 people per year (5). In adult onset (AO) GHD, an annual incidence of 1.2 per 100 000 adults has been estimated (6). To our knowledge, there have been no nationwide studies using uniform diagnostic and classification criteria for all citizens.…”

Concepts in the Diagnosis of Adult Growth Hormone Deficiency

“…Over 95% of patients with three or four pituitary deficiencies had peak GH on provocative testing of <2.5 µg/l. Similar results linking the severity of GHD to the number of pituitary deficits were also reported by others [3,4,5,6,7]. For patients with panhypopituitarism, the probability of having GHD is high enough that a low IGF-I might be the sole test needed to make a diagnosis of GHD.…”

GH Deficiency as The Most Common Pituitary Defect After TBI: Clinical Implications

“…The incidence of isolated GHD hormone relative to multiple pituitary deficiencies varies greatly. In some large postmarketing surveillance databases isolated GHD occurs appoximately in 10% [2] while in a French study up to 20% [3]. Some apparent differences are probably due to great variation in tests and criteria used.…”