Observational study in adult hypopituitary patients with untreated growth hormone deficiency (ODA study). Socio-economic impact and health status. Collaborative ODA (Observational GH Deficiency in Adults) Group

Abstract

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.

Metabolic Co-Morbidities Revealed in Patients with Childhood-Onset Adult GH Deficiency after Cessation of GH Replacement Therapy for Short Stature

“…Sanmarti et al reported that the prevalence of hypertension was higher in GH-deficient patients (22%) than in the general population in Spain [22]. In our series, hypertension was observed only in one male patient.…”

“…In this study, 90% (36/40) of the patients with gonadotropin deficiency were receiving sex hormone replacement therapy, although it was not clear whether the replacement of sex hormones affected the severity and number of metabolic comorbidities in our patients. Concerning the number of overlapped metabolic co-morbidities in one person in the Japanese general population, an analysis using Japanese criteria for metabolic syndrome, in a report by the Ministry of Health, Labour and Welfare, found the prevalence of Japanese men who had one, two, and three metabolic risk factors (dyslipidemia, elevated blood pressure, or glucose intolerance) increased with age from 31% (20-29 year age group) to 53% (50-59 year age group), from 4% (20-29) to 23% (50-59), and from 0.8% (20)(21)(22)(23)(24)(25)(26)(27)(28)(29) to 7% (50-59), respectively. The prevalence of Japanese women who had one, two, and three of these component factors increased from 5% (20-29 year age group) to 46% (50-59 year age group), from 0% (20-29) to 18% (50-59), and from 0% (20)(21)(22)(23)(24)(25)(26)(27)(28)(29) to 4% (50-59), respectively [5].…”

“…Concerning the number of overlapped metabolic co-morbidities in one person in the Japanese general population, an analysis using Japanese criteria for metabolic syndrome, in a report by the Ministry of Health, Labour and Welfare, found the prevalence of Japanese men who had one, two, and three metabolic risk factors (dyslipidemia, elevated blood pressure, or glucose intolerance) increased with age from 31% (20-29 year age group) to 53% (50-59 year age group), from 4% (20-29) to 23% (50-59), and from 0.8% (20)(21)(22)(23)(24)(25)(26)(27)(28)(29) to 7% (50-59), respectively. The prevalence of Japanese women who had one, two, and three of these component factors increased from 5% (20-29 year age group) to 46% (50-59 year age group), from 0% (20-29) to 18% (50-59), and from 0% (20)(21)(22)(23)(24)(25)(26)(27)(28)(29) to 4% (50-59), respectively [5]. Thus, a maximum of 7% of individuals (both men and women) between the ages of 20 and 59 yrs had three factors, although it was difficult to compare our data with the data in this report since the definitions and metabolic disorders differed in our study and abdominal circumference was not recorded in our patients.…”

Cardiovascular risk factors in hypopituitary GH-deficient adults

“…Sanmarti et al (24) conducted a retrospective study of the health status of 926 hypopituitary patients with adult-onset GHD who were not treated with GH, including 1-year follow-up data, which were available in 356 patients. Clinical evaluations and laboratory tests showed a higher incidence of cardiovascular risk factors.…”

Effects of GH treatment in GH-deficient adults on adiponectin, leptin and pregnancy-associated plasma protein-A.

“…Cardiovascular risk factors described in this population include altered body composition with truncal adiposity, detrimental changes in lipid profile, insulin resistance and impaired exercise capacity, among others (1)(2)(3)(4).…”