Body composition and quality of life in adults with growth hormone deficiency; effects of low‐dose growth hormone replacement

Ahmad, Aftab; Hopkins, Marion T.; Thomas, Joegi; Ibrahim, Hisham; Fraser, William D.; Vora, Jiten

doi:10.1046/j.1365-2265.2001.01275.x

Cited by 60 publications

(31 citation statements)

References 42 publications

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“…QOL was assessed by a variety of non-specific and disease-specific questionnaires in this study. In contrast to findings in several previous controlled and open-label studies (3,47,48), we were unable to demonstrate significant improvements in QOL. Several explanations are possible.…”

Section: Discussioncontrasting

confidence: 56%

Low-dose GH improves exercise capacity in adults with GH deficiency: effects of a 22-month placebo-controlled, crossover trial

Bollerslev¹,

Hallén²,

Fougner³

et al. 2005

eur j endocrinol

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Fifty-five patients with adult-onset GH deficiency (mean age, 49 years) were enrolled in a placebocontrolled, crossover study to investigate the effects of GH therapy on exercise capacity, body composition, and quality of life (QOL). GH and placebo were administered for 9 months each, separated by a 4-month washout period. GH therapy was individually dosed to obtain an IGF-I concentration within the normal range for age and sex. The final mean daily dose of GH was 1.2 IU/day for men and 1.8 IU/day for women. Mean IGF-I concentration at baseline was higher in men than in women (95^33 vs 68^41 mg/l respectively; P , 0.04) and increased to a similar level on GH therapy. Body fat mass was reduced by 1.9^2.9 kg and lean body mass was increased by 1.8^2.8 kg (P ¼ 0.0001 for each) with GH treatment. Total and low-density cholesterol levels decreased. Absolute maximal oxygen uptake increased by 6% (P ¼ 0.01), relative to body weight by 9% (P ¼ 0.004), and there was a trend toward increased endurance performance by 7% (P ¼ 0.07). There were no significant effects on QOL. In conclusion, treatment with a low, physiologic dose of GH produced positive effects on body composition and lipids and improved exercise capacity, likely to be of clinical relevance. No changes in QOL were seen, possibly because of a good QOL at baseline.

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Section: Discussioncontrasting

confidence: 56%

Low-dose GH improves exercise capacity in adults with GH deficiency: effects of a 22-month placebo-controlled, crossover trial

Bollerslev¹,

Hallén²,

Fougner³

et al. 2005

eur j endocrinol

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“…Fat mass is one of the most responsive external markers of the effects of GH in patients with GHD. Nevertheless, no relationship between changes in QoL and changes in fat mass, lean body mass, or IGF-I has been found in a variety of studies (11,18,19), except one which reported a significant correlation between body composition change as determined by bioelectrical impedance analysis and change in QoL score as measured with the disease-specific questionnaire, Quality of LifeAssessment of GHD in Adults (QoL-AGHDA) (20). Here, using DXA, we found significant associations between changes in general health and physical functioning subscales and fat mass change, with the trend being more consistent in AO than CO patients.…”

Section: Discussionmentioning

confidence: 99%

Heterogeneity in responsiveness of perceived quality of life to body composition changes between adult- and childhood-onset Japanese hypopituitary adults with GH deficiency during GH replacement

Urushihara¹,

Fukuhara²,

Tai³

et al. 2007

eur j endocrinol

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Objective: To examine the responsiveness of quality of life (QoL) associated with changes in clinical indices relevant to GH deficiency (GHD) in Japanese hypopituitary adults. Design and methods: QoL was determined using the Short Form (SF)-36 in Japanese adults with adult-(AO; nZ27) or childhood-(CO; nZ37) onset GHD in a 24-week double-blind placebo-controlled study with a fixed GH dose, and a subsequent 48-week open-label extension study with GH doses individualized using serum IGF-I levels. Results: Baseline QoL was significantly decreased from the Japanese national reference in both onset types, more so in AO patients. Throughout the study, AO patients showed a trend for an increase in physical functioning and general health (PZ0.0564 and 0.0999 respectively), whereas CO patients showed no changes in these domains. Fat mass changes negatively correlated with the changes in physical functioning and general health in AO patients (rZK0.42 and K0.64 respectively), but to a lesser degree in CO patients (rZK0.36 and K0.32 respectively). CO patients displayed significant decreases in social functioning (PZ0.0305) and mental health (PZ0.0442) and a decreasing trend in bodily pain (PZ0.0769), although no correlation between these decreases and any measured clinical index was observed, except between changes in bodily pain and IGF-I levels (rZK0.43). Conclusions: QoL impairment was evident in Japanese adults with GHD, particularly in AO patients. In AO patients, general health and physical functioning domains were responsive to fat mass changes during GH treatment; this association was not evident in CO patients. These relationships between QoL and body composition warrant verification.European Journal of Endocrinology 156 637-645

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“…In clinical studies, gender differences in the doses required to normalise IGF1 levels have indeed been noted in subgroup analyses, with females receiving a higher GH replacement dose than males in some studies (28,35), although some have found no significant differences in GH dose needed between men and women (22,45) when dose adjustments are made for baseline factors such as age, BMI, and dose of GH itself (46). Differences in the response to GH, as reflected by changes in body composition, have been observed, with several studies demonstrating greater effects in males than in females.…”

Section: Gendermentioning

confidence: 99%

“…Results suggested that 12 months of lowdose GH therapy normalised bone metabolism and cortical bone density, and improved trabecular bone density without causing adverse events. The effects of low-dose GH replacement on body composition and QoL were studied by Ahmad et al (22). A starting daily dose of 0.4-0.5 IU (0.13-0.17 mg) that was titrated to achieve and maintain IGF1 SDS between the median and upper end of the age-related reference range (mean GH dose of 0.77G0.08 IU at 1 month and 0.80 G0.12 IU at 3 months) was associated with an improvement in body composition and QoL.…”

Section: Weight-based Vs Individualised Regimensmentioning

confidence: 99%

THERAPY OF ENDOCRINE DISEASE: GH therapy in adult GH deficiency: A review of treatment schedules and the evidence for low starting doses

Gasco

Prodam

Grottoli

et al. 2013

European Journal of Endocrinology

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Recombinant human GH has been licensed for use in adult patients with GH deficiency (GHD) for over 15 years. Early weight-and surface area-based dosing regimens were effective but resulted in supraphysiological levels of IGF1 and increased incidence of side effects. Current practice has moved towards individualised regimens, starting with low GH doses and gradually titrating the dose according to the level of serum IGF1 to achieve an optimal dose. Here we present the evidence supporting the dosing recommendations of current guidelines and consider factors affecting dose responsiveness and parameters of treatment response. The published data discussed here lend support for the use of low GH dosing regimens in adult GHD. The range of doses defined as 'low dose' in the studies discussed here (w1-4 mg/week) is in accordance with those recommended in current guidelines and encompasses the dose range recommended by product labels. European Journal of Endocrinology 168 R55-R66

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Body composition and quality of life in adults with growth hormone deficiency; effects of low‐dose growth hormone replacement

Cited by 60 publications

References 42 publications

Low-dose GH improves exercise capacity in adults with GH deficiency: effects of a 22-month placebo-controlled, crossover trial

Low-dose GH improves exercise capacity in adults with GH deficiency: effects of a 22-month placebo-controlled, crossover trial

Heterogeneity in responsiveness of perceived quality of life to body composition changes between adult- and childhood-onset Japanese hypopituitary adults with GH deficiency during GH replacement

THERAPY OF ENDOCRINE DISEASE: GH therapy in adult GH deficiency: A review of treatment schedules and the evidence for low starting doses

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