The severity of growth hormone deficiency in adults with pituitary disease is related to the degree of hypopituitarism

Toogood, Andrew; Beardwell, Colin G; Shalet, Stephen M

doi:10.1111/j.1365-2265.1994.tb02583.x

Cited by 214 publications

(138 citation statements)

References 26 publications

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“…Toogood et al reported that the greater the number of pituitary hormone deficits the more severe the GH deficiency [13]. On the other hand, there was no correlation between the number of hormone deficiencies and the GH peak measured in the GH provocative test in this study.…”

Section: Discussioncontrasting

confidence: 53%

Metabolic Disorders in Adult Growth Hormone Deficiency: A Study of 110 Patients at a Single Institute in Japan

et al. 2006

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Abstract. The purpose of this study carried out at a single institute in Japan was to investigate the clinical characteristics and complications of patients with adult growth hormone deficiency (GHD). Clinical and biochemical data of 110 patients (50 males, 60 females; mean age 42 ± 17 yr) with adult GHD who attended Tokyo Women's Medical University between 1990 and 1999 were analyzed retrospectively from medical records. This retrospective analysis demonstrated that 109 patients had multiple pituitary hormone deficiencies, with 98 patients having a deficiency of more than three hormones. Sixty-one patients had childhood onset GHD (COGHD) while the remaining 49 patients had adulthood onset GHD (AOGHD). Body mass index (BMI) ranged from 16.9 to 35.9 with a mean of 23.9 ± 4.1 (kg/m 2 ), with BMI being ≥25 kg/ m 2 in 38 patients (31% of COGHD and 38% of AOGHD). Forty-one percent of the patients had hypercholesterolemia, 41% had hypertriglyceridemia, 47% had decreased levels of HDL cholesterol and 48% had increased levels of LDL cholesterol. Intima-media thickness (IMT) of the carotid arteries was investigated in 33 patients, with abnormal findings including increased IMT or plaque being observed in 4 of 18 COGHD patients and 4 of 15 AOGHD patients. Diabetes mellitus and impaired glucose tolerance was found in 4 COGHD patients and 16 AOGHD patients. Insulin resistance was assessed in 36 patients by the homeostasis model insulin resistance index (HOMA-R) and ranged from 0.65 to 10.58 with a mean of 2.80 ± 0.37. This mean value of HOMA-R was significantly greater than that measured in normal subjects (1.58 ± 0.05: P<0.05). These data suggest that abnormal lipid and glucose metabolism, and atherosclerotic changes occur frequently in adult patients with GHD. Insulin resistance may play a role in glucose and lipid metabolism disorders associated with GHD.

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Section: Discussioncontrasting

confidence: 53%

Metabolic Disorders in Adult Growth Hormone Deficiency: A Study of 110 Patients at a Single Institute in Japan

et al. 2006

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“…This observation leads to the understanding that the 'gold standard' for diagnosing severe GHD is not a particular provocation test threshold response but rather the presence of MPHD. Confirmatory data published in the same year (1994) by Toogood et al (16), with a much larger cohort of patients, supported the belief that, even if arbitrarily defined, a peak GH threshold of 3 ng/ml to an ITT was a reasonable starting point for deciding which patients qualified for the advancing use of GH replacement in adults.…”

Section: Definition Of Ghdsupporting

confidence: 60%

EXTENSIVE EXPERTISE IN ENDOCRINOLOGY: UK stance on adult GH replacement: the economist vs the endocrinologist

Shalet

2013

European Journal of Endocrinology

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In the UK, through the use of a forced economic model, endocrinologists are in the curious position of offering GH replacement to some patients with severe GH deficiency (GHD) but withholding it from other patients with even more severe GHD. This approach is counter-intuitive to endocrine practice in treating endocrine deficiency states. For all other endocrine deficiencies, one would opt for treating those with the most severe biochemical evidence of deficiency first. If this endocrine approach was applied to adult GH replacement in an era of rationing, one would start with the GHD patients with a pathologically low IGF1 level. Given that the prevalence of subnormal IGF1 levels in a GHD population is age-dependent, this would result in GH replacement being offered to more young adult onset (AO) GHD and childhood onset GHD adults, and less often to middle-aged and elderly AO GHD adults. This in itself has the added advantage that the skeletal benefits appear more real in the former cohort of patients.

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“…A policy of dynamic testing of GH reserve was not universally applied to the Birmingham cohort pre‐2002. However, IGF‐1 levels below age and sex‐derived reference ranges, in the setting of deficiencies of at least two other pituitary hormones, have been validated as a reasonable diagnostic alternative in cases where ITT is not available 20, 40. Although desirable, complete homogeneity of dynamic testing strategies is not realistic when combining pituitary function data from different centres.…”

Section: Discussionmentioning

confidence: 99%

ACTH and gonadotropin deficiencies predict mortality in patients treated for nonfunctioning pituitary adenoma: long‐term follow‐up of 519 patients in two large European centres

O’Reilly

Reulen

Gupta

et al. 2016

Clinical Endocrinology

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SummaryContext and ObjectiveNonfunctioning pituitary adenomas (NFPAs) are the most common subtype of pituitary tumour. Hypopituitarism is observed in NFPAs due to tumour‐ or treatment‐related factors and may increase mortality risk. Here, we analysed the associations of hypopituitarism, hormone replacement and mortality in a large NFPA cohort derived from two large European centres.Design, Setting and ParticipantsCase note review of all patients treated for NFPA in University Hospitals Birmingham and Beaumont Hospital Dublin between 1999 and 2014 was performed.Main Outcome MeasuresClinical presentation, treatment strategies, pituitary function and vitality status were recorded in each patient. A multivariate Cox regression model was used to examine the association between hypopituitarism, hormone replacement and premature mortality.ResultsA total of 519 patients were included in the analysis. Median duration of follow‐up was 7·0 years (0·5–43). A total of 81 deaths were recorded (15·6%). On multivariate analysis, adrenocorticotropic hormone (ACTH) and gonadotropin (Gn) deficiencies were associated with an increased relative risk of death (OR 2·26, 95% CI 1·15–4·47, P = 0·01 and OR 2·56, 95% CI 1·10–5·96, P = 0·01, respectively). Increased hydrocortisone (HC) (P‐trend = 0·02) and lower levothyroxine (LT4) doses (P‐trend = 0·03) were associated with increased risk of death. Mortality increased with the degree of pituitary failure observed (P‐trend = 0·04).ConclusionACTH and gonadotropin‐deficient patients have higher mortality rates compared to those with intact hormonal axes. Excessive HC and suboptimal LT4 replacement may also increase risk of death. Complex associations between hormone deficiency and replacement underpin the increased mortality risk in NFPA patients.

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The severity of growth hormone deficiency in adults with pituitary disease is related to the degree of hypopituitarism

Abstract: Our study has shown that GH deficiency is variable according to the degree of hypopituitarism present and that the greater the number of pituitary hormone deficits the more severe the GH deficiency. These observations will help to clarify the diagnosis of GH deficiency in adult life.

Cited by 214 publications

References 26 publications

Metabolic Disorders in Adult Growth Hormone Deficiency: A Study of 110 Patients at a Single Institute in Japan

Metabolic Disorders in Adult Growth Hormone Deficiency: A Study of 110 Patients at a Single Institute in Japan

EXTENSIVE EXPERTISE IN ENDOCRINOLOGY: UK stance on adult GH replacement: the economist vs the endocrinologist

ACTH and gonadotropin deficiencies predict mortality in patients treated for nonfunctioning pituitary adenoma: long‐term follow‐up of 519 patients in two large European centres

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