Decreased Quality of Life in Adult Patients with Growth Hormone Deficiency Compared with General Populations Using the New, Validated, Self-Weighted Questionnaire, Questions on Life Satisfaction Hypopituitarism Module

Abstract

To develop reference ranges for the Questions on Life Satisfaction Hypopituitarism Module (QLS-H), a new quality of life questionnaire for patients with hypopituitarism, data from 8177 adults were collected in France, Germany, Italy, The Netherlands, Spain, the United Kingdom, and the United States QLS-H scores declined with age, were lower in females than males, and differed significantly among countries. From these reference ranges we derived equations for z-scores, which adjust for age, gender, and country. QLS-H results from 957 adults with GH deficiency (GHD) participating in clinical trials were analyzed. At baseline, QLS-H scores were lower in females and differed significantly among countries. QLS-H scores significantly increased after GH treatment (6-8 months), but differences by country persisted. Calculating z-scores for patients eliminated all gender and most country differences. Pooled z-scores (mean +/- SD) from all patients increased from -0.99 +/- 1.39 at baseline to -0.14 +/- 1.30 after GH treatment. Quality of life assessment in adults with GHD requires the use of z-scores to correct for age, gender, and country differences. This approach allows pooling of data from different cohorts and comparison with general populations. QLS-H scores in adults with GHD were significantly decreased at baseline and were almost normalized after 6-8 months of GH therapy.

Prevalence of Pituitary Hormone Dysfunction, Metabolic Syndrome, and Impaired Quality of Life in Retired Professional Football Players: A Prospective Study

“…Specifically, because it relates to the findings of GHD and hypogonadism in this study, GH replacement is known to improve QoL in patients with adult-onset GHD and helps reduce fat mass and improve exercise capacity. 51,52,54,55,[74][75][76][77][78][79][80] The benefits of testosterone therapy for men are clear and considered standard practice. 50,57,81 In addition, the high prevalence of MetS in retired football players is important because lifestyle changes may reverse some of these findings and improve the cardiovascular and metabolic disease risks that are associated with MetS.…”

“…Both GHD and hypogonadism have been associated with poor QoL. [49][50][51][52][53][54][55][56][57][58][59][60] In addition to poor QoL, both GHD and hypogonadism can contribute to decreased lean body mass, increased fat mass (in particular, visceral fat), and poor exercise capacity that further contribute to poor QoL, obesity, and MetS, increasing cardiovascular disease (CVD) risk. 51,54,57,[61][62][63][64][65][66][67][68][69][70] Studies have shown that MetS is associated with, and predicts the development of, low serum testosterone levels in men.…”

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

“…Subsequently, two disease-specific questionnaires designed for patients with adult GHD were developed, namely the adult growth hormone deficiency assessment (AGHDA) questionnaire (17) and the Questions on Life Satisfaction-Hypopituitarism questionnaire (QLS-H) (18). Over the last 25 years, they have confirmed that patients with AGHD or hypopituitarism have impaired QoL, as well as decreased bone and muscle mass, increased fat mass, reduced physical performance, an unfavourable lipid profile and increased insulin resistance (19).…”

“…Although challenged by some, in countries like the UK, a bad QoL score on AGHDA (>11) is a criterion to initiate substitution treatment with rhGH in AGHD and to maintain it (since an improvement of at least 7 points on the AGHDA score is to be evidenced) ( (22) The QLS-H questionnaire has the advantage of weighting each item by the individual patient. Patients are first asked how important each item is to them and later how satisfied they are with each item (18,19). The disadvantage in relation to AGHDA is that the score calculation is more complex and usually requires a computer programme.…”

Improving Quality of Life in Patients with Pituitary Tumours

“…That is why diseasespecific questionnaires have been developed, more sensitive to detect subtle changes in QoL in a determined disease (for instance, improvement after treatment). For pituitary adenomas, questionnaires often used are AcroQoL for acromegaly, 8 CushingQoL for Cushing's syndrome (CS) 9,10 and Adult Growth Hormone Deficiency Assessment (AGHDA) 11 or Questions on Life Satisfaction-Hypopituitarism (QLS-H) for growth hormone (GH) deficiency 12,13 (see Table 1). …”