Growth hormone deficiency and replacement in hypopituitary patients previously treated for acromegaly or Cushing's disease.
OBJECTIVE
To compare baseline characteristics in adult patients with growth hormone (GH) deficiency (GHD) who had previously been treated for Cushing's disease or acromegaly with data from patients with GHD of other aetiologies. To study the effects of GH therapy in those patients who had completed at least 6 months of GH replacement.


METHODS
Data from a large outcomes research database (KIMS (Pharmacia International Metabolic Database)).


METHODS
135 patients were identified with previous Cushing's disease, 40 had had acromegaly, and 1392 had GHD of other aetiologies. The number of additional hormone deficiencies, and the mean age of the patients were similar in the three groups. Similar proportions of patients in each group were treated using surgery, but radiotherapy was used more often in patients with acromegaly than those with other diagnoses.


RESULTS
At baseline, the prevalence of diabetes mellitus and hypertension were significantly higher in the group treated for Cushing's disease, and the prevalence of stroke was significantly higher in the group treated for acromegaly. The incidence of coronary heart disease and claudication were similar in all three groups. Patients treated for Cushing's disease had lower bone mineral density and suffered fractures more often than other GHD adults. Body mass index, waist-hip ratio, serum concentrations of lipids and standard deviation scores of serum concentrations of insulin-like-growth factor-I were similar in the three groups. The dose of GH administered was comparable in the three groups and the effects of GH replacement on waist circumference, blood pressure and quality of life were also similar across the groups. The numbers and types of adverse events reported were not different between the groups.


CONCLUSIONS
These data suggest that the characteristics of patients in these diagnostic groups depend on the primary disease which resulted in GHD, and that the clinical expression of GHD does not differ between the groups. Patients with previous hypercortisolism showed more long-term effects of their disease, such as diabetes mellitus, hypertension and fractures. A benefit from GH replacement was evident in patients previously treated for acromegaly and Cushing's disease particularly in relation to quality of life.
Feldt-Rasmussen
Ulla
U
Department of Endocrinology, Rigshospitalet, National University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark. ufeldt@rh.dk
Abs
Roger
R
Bengtsson
Bengt-Ake
BA
Bennmarker
Helge
H
Bramnert
Margareta
M
Hernberg-Ståhl
Elizabeth
E
Monson
John P
JP
Westberg
Björn
B
Wilton
Patrick
P
Wüster
Christian
C
D000172:Acromegaly / Q000150:complications* / Q000628:therapy; D000328:Adult; D000368:Aged; D015519:Bone Density; D003480:Cushing Syndrome / Q000150:complications* / Q000628:therapy; D016208:Databases, Factual; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D013006:Growth Hormone / Q000627:therapeutic use*; D006728:Hormones / Q000097:blood / Q000172:deficiency; D019382:Human Growth Hormone / Q000172:deficiency*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology; D007018:Hypopituitarism / Q000188:drug therapy* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D011863:Radioimmunoassay; D020521:Stroke / Q000453:epidemiology; D016896:Treatment Outcome
D006728:Hormones; D019382:Human Growth Hormone; D013006:Growth Hormone