Increased fracture frequency in adult patients with hypopituitarism and GH deficiency

Rosén, Thord; Wilhelmsen, Lars; Landin‐Wilhelmsen, Kerstin; Lappas, Georg; Bengtsson, Bengt‐Åke

doi:10.1530/eje.0.1370240

Cited by 258 publications

(150 citation statements)

References 23 publications

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“…Rosen et al (35) showed a threefold increase in fracture rate in hypopituitary patients from a single centre compared with a group of mixed European population (the MONICA project). The odds ratios for fracture frequency were 3.97 and 2.64 in men and women respectively.…”

Section: Discussionmentioning

confidence: 99%

The clinical, metabolic and endocrine features and the quality of life in adults with childhood-onset craniopharyngioma compared with adult-onset craniopharyngioma

Kendall‐Taylor¹,

Jönsson²,

Abs³

et al. 2005

eur j endocrinol

114

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Background: Craniopharyngioma is a parasellar tumour that, although benign, tends to behave aggressively. It can occur at any age but most commonly presents in childhood or adolescence. Objectives: To investigate the frequency and severity of problems associated with craniopharyngioma, using the large international database (KIMS) for adult patients with GH deficiency (GHD), and to assess the differences between the adult onset (AO, aged 18 or above) disease and adults with childhood onset (CO) craniopharyngioma. Design: Inclusion criteria were: an established diagnosis of craniopharyngioma, severe GHD and no recent GH treatment. These criteria were fulfilled by 393 (184 female, 209 male) patients; 241 had AO (mean age 28.7^8.7 years) and 152 had CO disease (age 42.0^12.3 years). Disease history, clinical features and anthropometric data were recorded at the time of enrolment in the database, and body composition, serum IGF-I, serum lipids and quality of life (QoL) were assessed. Results: Peak age at onset of craniopharyngioma was 15-20 years. Ninety percent of patients had been treated surgically. CO patients were shorter than AO patients and had much lower IGF-I standard deviation scores (SDS). The majority had hypopituitarism and over 60% had diabetes insipidus. Body mass index (BMI) was higher in AO males (30.2^5.5) than in CO males (28.5^7.5); waist circumference was also greater. Obesity was more common in AO patients (51.8% vs 39.1%). Body composition did not differ between groups. Cholesterol and triglycerides were higher in AO than in CO patients, but high density lipoprotein (HDL)-and low density lipoprotein (LDL)-cholesterol did not differ. Quality of life, assessed by Quality of Life-Assessment of Growth Hormone Deficiency in Adults (QoL-AGHDA) and the Nottingham Health Profile, was markedly reduced in all groups with no significant differences between them; the QoL-AGHDA score correlated with age at onset of both craniopharyngioma and GHD, and also with BMI in AO patients. Conclusions: These data emphasise the generally poor state of health of patients treated for craniopharyngioma, with respect to endocrine and metabolic function, and also the markedly reduced quality of life. In addition to GHD, most patients have evidence of hypothalamic damage with associated obesity, diabetes insipidus and hypopituitarism. Adults with CO craniopharyngioma were shorter, had lower IGF-I, lower BMI, less obesity and slightly lower blood lipid levels than patients with AO craniopharyngioma.

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Section: Discussionmentioning

confidence: 99%

The clinical, metabolic and endocrine features and the quality of life in adults with childhood-onset craniopharyngioma compared with adult-onset craniopharyngioma

Kendall‐Taylor¹,

Jönsson²,

Abs³

et al. 2005

eur j endocrinol

114

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“…GHD is associated with decreased bone mineral density (BMD) in GHD children, COGHD adults and AOGHD adults, reflecting decreased bone accretion and/or reduced bone turnover (reviewed by Monson et al 2002, Verhelst & Abs 2002. The reduced BMD in AOGHD is associated with an increased incidence of fractures, particularly in men (Rosen et al 1997). Osteoporosis is similarly prevalent in untreated GH-resistant LS patients (Laron 2001).…”

Section: Body Compositionmentioning

confidence: 99%

Growth hormone therapy and Quality of Life: possibilities, pitfalls and mechanisms

Hull

Harvey²

2003

Journal of Endocrinology

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The actions of growth hormone (GH) are not restricted to growth: GH modulates metabolic pathways as well as neural, reproductive, immune, cardiovascular, and pulmonary physiology. The importance of GH in most physiological systems suggests that GH deficiency at any age would be associated with significant morbidity. However, prior to the advent of recombinant GH, cadaverderived GH was only used therapeutically to correct the height deficit, and thereby hypothetically improve quality of life (QoL), in GH-deficient children. Physicians now have access to unlimited, albeit expensive, supplies of recombinant GH, and are considering the advisability of GH replacement or supplementation in other patient populations. This paper analyses studies investigating the relationship between GH and QoL in GH-deficient children or adults, in GH-replete short children suffering from idiopathic short stature, Turner syndrome, or intrauterine growth retardation and in GH-deficient or replete elderly adults. Possible mechanisms by which GH might improve QoL at neural and somatic sites are also proposed.

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“…Pacientes com deficiência de GH têm redução na DMO e risco aumentado de fraturas, associados a diminuição do processo de remodelação óssea (47,48). Três de nossos pacientes tiveram diagnóstico de osteoporose na avaliação basal e 27 tiveram diagnóstico de osteopenia, ou seja, 43% dos pacientes apresentavam algum grau de redução de DMO com conseqüente aumento no risco de fraturas, sendo a maioria com deficiência de GH de início na infância.…”

Section: Deficiência De Gh Em Adultos: Estudo Brasileirounclassified

Deficiência de GH em adultos: resultados do estudo multicêntrico brasileiro

Conceição

Boguszewski

Meister

et al. 2003

Arq Bras Endocrinol Metab

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RESUMOAvaliamos 70 pacientes com deficiência de GH, 39 mulheres e 31 homens, com idades entre 18 e 69 anos (média de 38,3±13,5), provenientes de 3 centros no Brasil. A dose de reposição variou entre os centros, bem como a resposta do IGF-1, que mostrou maior aumento nos centros com maior dose de GH. Reposição de GH levou a um aumento significativo nos níveis de IGF-1 e HDL colesterol, bem como da densidade mineral óssea (DMO), e a uma redução significativa nos níveis de colesterol total e LDL colesterol, semelhante nos 3 centros. Encontramos aumento mais significativo de HDL colesterol nas mulheres e aumento mais acentuado da DMO nos pacientes do sexo masculino. Concluimos que reposição de GH leva à melhora do perfil lipídico e da DMO, e que doses menores apresentam o mesmo benefício, provavelmente com menor incidência de efeitos colaterais. ABSTRACT GH Deficiency in Adults: Results of the Brazilian Multicenter Study.We have evaluated 70 patients with GH deficiency, 39 females and 31 males, ranging in age from 18 to 69 years (mean: 38.3±13.5), from 3 centers in Brazil. GH replacement dose was different among the centers, as well as IGF-1 response to GH, which was more pronounced in patients using the highest GH dose. GH replacement led to a significant increase of IGF-1 and HDL cholesterol, as well as bone mineral density (BMD) and to a significant decrease in total and LDL cholesterol that was similar among the centers. Female patients showed a more significant increase of HDL cholesterol, while men showed a more significant increase of BMD. In conclusion, GH replacement led to an improvement of lipid profile and BMD. Lower GH dose may lead to the same benefits, probably with a lower incidence of side effects.

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Increased fracture frequency in adult patients with hypopituitarism and GH deficiency

Cited by 258 publications

References 23 publications

The clinical, metabolic and endocrine features and the quality of life in adults with childhood-onset craniopharyngioma compared with adult-onset craniopharyngioma

The clinical, metabolic and endocrine features and the quality of life in adults with childhood-onset craniopharyngioma compared with adult-onset craniopharyngioma

Growth hormone therapy and Quality of Life: possibilities, pitfalls and mechanisms

Deficiência de GH em adultos: resultados do estudo multicêntrico brasileiro

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