Dehydroepiandrosterone Improves Psychological Well-Being in Male and Female Hypopituitary Patients on Maintenance Growth Hormone Replacement

Abstract

Context: Patients with panhypopituitarism have impaired quality of life (QoL) despite GH replacement. They are profoundly androgen deficient, and dehydroepiandrosterone (DHEA) has been shown to have a beneficial effect on well-being and mood in patients with adrenal failure and possibly in hypopituitarism. Objective: Our objective was to determine the effect of DHEA administration on mood in hypopituitary adults on established GH replacement with a constant serum IGF-I. Design: A double-blind, placebo-controlled trial was conducted over an initial 6 months followed by an open phase of 6 months of DHEA. Setting: The study was conducted at a tertiary referral endocrinology unit. Patients: Thirty female and 21 male hypopituitary patients enrolled. Data from 26 females and 18 males were analyzed after patient withdrawal. Interventions: DHEA (50 mg) was added to maintenance replacement including GH. Main Outcome Measures: The primary outcome objective was the effect on QoL and libido assessed by QoL assessment in GH deficiency in adults, Short Form 36, General Health Questionnaire, EuroQol, and sexual self-efficacy scale. Results: Patients had impaired QoL at baseline compared with the age-matched British population. Females showed improvement in QoL assessment in GH deficiency in adults score (−2.9 ± 2.8 DHEA vs.−0.53 ± 3 placebo; P < 0.05), in Short Form 36 social functioning (14.6 ± 23.1 DHEA vs.−4.7 ± 25 placebo; P = 0.047), and general health perception (9.6 ± 14.2 DHEA vs.−1.2 ± 11.6 placebo; P = 0.036) after 6 months of DHEA. Men showed improvement in self-esteem (−1.3 ± 1.7 DHEA vs. 0.5 ± 1.5 placebo; P = 0.03) and depression (−1.6 ± 2.2 DHEA vs. 1.2 ± 2.4 placebo, P = 0.02) domains of the General Health Questionnaire after 6 months of DHEA. Conclusions: DHEA replacement leads to modest improvement in psychological well-being in female and minor psychological improvement in male hypopituitary patients on GH replacement.

Long-term DHEA substitution in female adrenocortical failure, body composition, muscle function, and bone metabolism: a randomized trial

“…All reports related to skin problems and probably reflect stimulation of the pilosebaceous unit. Our findings are consistent with the frequency reported in previous trials (9)(10)(11)(12)(13)(14) and it may be concluded that the skin is the most DHEA sensitive organ. However, attempts to evaluate this phenomenon with sebutape (14) and body hair score (11) have failed.…”

“…In accordance with our previous shortterm study on GH secretory patterns (8), we did not find any augmentation of GH derived growth factors or their binding proteins. Slightly stimulated IGF1 levels are reported in some (9,14,15) but not all studies (8,12,13,33). In a 3 months study with DHEA or placebo treatment (50 mg) to a group of middle aged female Addison patients insulin sensitivity increased (33), while others found unchanged insulin sensitivity (11,31).…”

“…Substitution therapy with an oral dose of 50 mg of the adrenal androgen DHEA is followed by normalization of the spectrum of circulating androgens including testosterone (7)(8)(9). Questionnaires in controlled clinical trials have shown some (9)(10)(11)(12) or no (13)(14)(15)) effects on quality of life, and a high proportion of self-reported skin related side effects (9-11, 13, 14). Substantial physiological alterations upon androgen substitution with DHEA in female adrenocortical failure are still controversial and probably obscured by the associated hormone deficiencies (i.e.…”

Group 4: Replacement therapy for adrenal insufficiency

“…The principle unwanted effects of DHEA replacement are androgenic including hirsutism, seborrheic skin, acne and an androgenic sweat odor [74]. The effect of DHEA on deterioration of quality of life in patients with hypopituitarism is small but the impact of a deficit in only ACTH on the quality of life of these patients is not known [75]. There are no solid data concerning the beneficial effects of androgen replacement in male subjects with adrenal insufficiency.…”

Rehabilitation in Endocrine Patients: A Novel Psychosomatic Approach

“…The evidence that has accumulated on treatment of growth hormone deficiency [2,21,22,23,24,25] should lead endocrinologists to a multidimensional consideration of treatment effects, encompassing also psychosocial parameters. For instance, the differential effects on quality of life that are entailed by differences in replacement therapy are frequently acknowledged in the newsletters of patients’ associations and are receiving increasing research attention [6,51,52,53,54,55,56]. Adequate communication between endocrinologist and patient should be assured, with opportunities for discussion, negotiation and clarification, based on adequate assessment of all relevant biological, psychological, social and cultural factors.…”