Influences on quality of life in GH deficient adults and their effect on response to treatment

Murray, Robert; Skillicorn, C J; Howell, Simon; Lissett, Catherine A; Rahim, Asad; Smethurst, L; Shalet, Stephen M

doi:10.1046/j.1365-2265.1999.00838.x

Cited by 96 publications

(73 citation statements)

References 23 publications

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“…This differential responsiveness by onset type may be influenced by differences between AO and CO patients in the degree of baseline impairment in these domains. QoL improvements under GH replacement have in fact been reported to be more pronounced in patients with more severe impairment at baseline (21). In our multivariate model, although the change score for physical functioning was greater in patients with lower baseline scores, this was not the case for general health, for which baseline status did not influence changes despite considerable baseline differences between onsets.…”

Section: Discussionmentioning

confidence: 46%

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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Section: Discussionmentioning

confidence: 46%

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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“…However, several studies have examined correlations between baseline variables (i.e., before the start of GH replacement therapy) and later improvement in QOL [26] or baseline predictors of later improvement in QOL [27]. In a KIMS database study, Svensson et al [26] found that baseline QOL (assessed using the QOL-Assessment of GHD in Adults instrument [QOL-AGHDA]), serum HDL-C concentrations, and the duration of hypopituitarism were negatively correlated with QOL at 12 months.…”

Section: Funding Supportmentioning

confidence: 99%

“…In a KIMS database study, Svensson et al [26] found that baseline QOL (assessed using the QOL-Assessment of GHD in Adults instrument [QOL-AGHDA]), serum HDL-C concentrations, and the duration of hypopituitarism were negatively correlated with QOL at 12 months. In a small-scale (N = 65), open-label study, Murray et al [27] found that baseline QOL (QOL-AGHDA/Psychological General Wellbeing Schedule) and the age of onset of GHD were the most important predictors of improvement in QOL after up to 24 months of GH replacement therapy as determined by multiple linear regression analysis. The findings from these studies suggest that some baseline variables may be associated with long-term changes in QOL after the start of GH replacement therapy, but are clearly not directly comparable with the findings of our study given the different timing of assessments.…”

Section: Funding Supportmentioning

confidence: 99%

Possible predictors for QOL improvement following GH replacement therapy in adult GHD

et al. 2015

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ADULT GH DEFICIENCY (GHD) manifests as a clinical syndrome that is characterized by a number of abnormal physical and metabolic changes, including changes in body composition, lipid and carbohydrate metabolic profiles, bone mineral density, cardiac function, muscle strength, and aerobic capacity [1]. In addition, GHD can have a negative impact on cognitive function and quality of life (QOL) [1,2], particularly in adults with adult-onset (AO) GHD [3,4] Abstract. In addition to impaired physical activity, adult GH deficiency (GHD) can decrease quality of life (QOL). Hence, assessment of QOL is important to evaluate the efficacy of GH replacement therapy. This study aimed to identify factors that may be predictive of long-term improvement in QOL among clinical/laboratory variables during GH replacement therapy

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“…Curiously and unexplained, severe impairment of QoL is more frequently seen in adult patients with adult onset (AO) GHD compared with patients with childhood onset (CO) GHD (23).…”

Section: Quality Of Lifementioning

confidence: 99%

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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Influences on quality of life in GH deficient adults and their effect on response to treatment

Cited by 96 publications

References 23 publications

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

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

Possible predictors for QOL improvement following GH replacement therapy in adult GHD

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

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