title: Baseline characteristics and response to 2 years of growth hormone (GH) replacement of hypopituitary patients with GH deficiency due to adult-onset craniopharyngioma in comparison with patients with nonfunctioning pituitary adenoma: data from KIMS (Pfizer International Metabolic Database).
abstract: OBJECTIVE
  In epidemiological studies, hypopituitary adults show increased mortality compared with population controls. Patients with hypopituitarism caused by a craniopharyngioma (CP) and/or its treatment have a higher mortality than patients with other etiologies, such as a nonfunctioning pituitary adenoma (NFPA). To analyze this difference, we used the KIMS database (Pfizer International Metabolic Database) comparing CP and NFPA patients in terms of baseline characteristics and responses to GH replacement.
  
  
  METHODS
  Baseline characteristics were studied in 351 CP patients (189 men and 162 women; mean age, 42.5 yr) and compared with 370 NFPA patients, matched for age and sex (185 men and 185 women; mean age, 42.5 yr). The effects of 2 yr of GH replacement were analyzed in a subgroup of 183 CP and 209 NFPA patients.
  
  
  RESULTS
  At baseline, both CP and NFPA patients had characteristic features of GH deficiency, with low serum IGF-I, increased body fat, dyslipidemia, and reduced quality of life. Male CP patients were significantly more obese (30.0 vs. 28.2 kg/m2; P = 0.0003) compared with NFPA patients, had a higher waist/hip ratio (P = 0.004), higher triglycerides (P = 0.003), and lower high-density lipoprotein cholesterol (P = 0.03). Similar, but much smaller, differences were seen in female CP compared with NFPA patients, only reaching significance for waist/hip ratio (P = 0.05) and triglycerides (P = 0.0004). CP patients had more often undergone surgery by the transcranial route (68.8% vs. 30.9%; P < 0.0001), and panhypopituitarism was more prevalent in CP than in NFPA patients (58.7% vs. 19.8%; P < 0.0001). The incidence of previous fractures, hypertension, coronary heart disease, claudication, and diabetes mellitus was high, but not different, between CP and NFPA patients. After 2 yr of GH replacement therapy, similar significant improvements were evident in both groups in fat-free mass, total and low-density lipoprotein cholesterol, and Quality-of-Life-Assessment in GH Deficient Adults score compared with baseline. In contrast to NFPA patients, CP patients had no significant decrease in body fat with GH therapy.
  
  
  CONCLUSIONS
  In the KIMS database, patients with CP have more often undergone surgery by the transcranial route than patients with NFPA, have a higher prevalence of pituitary deficiencies, are more obese (predominantly males), and have more dyslipidemia. This could provide an explanation, at least in part, for the higher mortality rate in CP patients observed in epidemiological studies. CP patients respond equally well to GH therapy in fat-free mass, lipids, and quality of life, but are less likely to lose body fat. We assume that this difference in response merely reflects the stronger tendency of CP patients to accumulate fat over time.
authors.affiliation: General Hospital Middleheim, Antwerp, Belgium. johan.verhelst@zna.be
authors.forename: Johan
authors.initials: J
authors.lastname: Verhelst
authors.forename: Pat
authors.initials: P
authors.lastname: Kendall-Taylor
authors.forename: Eva Marie
authors.initials: EM
authors.lastname: Erfurth
authors.forename: David Anthony
authors.initials: DA
authors.lastname: Price
authors.forename: Mitchell
authors.initials: M
authors.lastname: Geffner
authors.forename: Maria
authors.initials: M
authors.lastname: Koltowska-Häggström
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Jönsson
authors.forename: Patrick
authors.initials: P
authors.lastname: Wilton
authors.forename: Roger
authors.initials: R
authors.lastname: Abs
mesh_terms: D000236:Adenoma / Q000150:complications* / Q000401:mortality / Q000601:surgery; D000328:Adult; D017668:Age of Onset; D001786:Blood Glucose; D001823:Body Composition; D015897:Comorbidity; D003397:Craniopharyngioma / Q000150:complications* / Q000401:mortality / Q000601:surgery; D016208:Databases, Factual; D005215:Fasting; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D019382:Human Growth Hormone / Q000172:deficiency / Q000627:therapeutic use*; D006801:Humans; D007018:Hypopituitarism / Q000188:drug therapy* / Q000209:etiology* / Q000401:mortality; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000150:complications* / Q000401:mortality / Q000601:surgery; D015995:Prevalence; D011788:Quality of Life; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I; D008055:Lipids