title: Changing patterns of the adult growth hormone deficiency diagnosis documented in a decade-long global surveillance database.
abstract: BACKGROUND
  GH therapy in adult patients with GH deficiency (GHD) was approved over 10 yr ago, and the indication has subsequently gained broad acceptance. The HypoCCS surveillance database is a suitable means to examine the evolution of diagnostic patterns since 1996.
  
  
  METHODS
  Baseline demographics, reported cause of GHD, and diagnostic tests were available from 5893 GH-treated patients. Trends for change over time in diagnosis, GH stimulation test data, and IGF-I measurements were analyzed at 2-yr intervals by linear regression models, with entry year as the predictive variable.
  
  
  RESULTS
  Over the decade, there was a decrease in patients enrolled with diagnoses of pituitary adenoma (50.2 to 38.6%; P < 0.001), craniopharyngioma (13.3 to 8.4%; P = 0.005) and pituitary hemorrhage (5.8 to 2.8%; P = 0.001); increases in idiopathic GHD (13.9 to 19.3%; P < 0.001), less common diagnoses (7.4 to 15.8%; P < 0.001), and undefined/unknown diagnoses (1.3 to 8.6%; P < 0.001) were observed. Use of arginine, clonidine, and L-dopa tests declined, whereas use of the GHRH-arginine test increased. Median values for peak GH from all tests except GHRH-arginine and for IGF-I SD scores increased significantly (P < 0.001). Over the decade (1996--2005), idiopathic GHD was reported for 16.7% of patients, and more than half of these had adult onset GHD. In the idiopathic adult onset group, 40.2% had isolated GHD; 18.3 and 4.4% had a stimulation test GH peak of at least 3.0 and 5.0 microg/liter, respectively.
  
  
  CONCLUSIONS
  Significant shifts in diagnostic patterns have occurred since approval of the adult GHD indication, with a trend to less severe forms of GHD.
authors.affiliation: Department of Endocrinology, Hospital Santa Creu i Sant Pau, Autonomous University of Barcelona, Pare Claret 167, 08025 Barcelona, Spain. swebb@santpau.cat
authors.forename: Susan M
authors.initials: SM
authors.lastname: Webb
authors.forename: Christian J
authors.initials: CJ
authors.lastname: Strasburger
authors.forename: Daojun
authors.initials: D
authors.lastname: Mo
authors.forename: Mark L
authors.initials: ML
authors.lastname: Hartman
authors.forename: Shlomo
authors.initials: S
authors.lastname: Melmed
authors.forename: Heike
authors.initials: H
authors.lastname: Jung
authors.forename: Werner F
authors.initials: WF
authors.lastname: Blum
authors.forename: Andrea F
authors.initials: AF
authors.lastname: Attanasio
mesh_terms: D000328:Adult; D017668:Age of Onset; D001120:Arginine / Q000032:analysis; D016208:Databases, Factual; D003940:Diagnostic Techniques, Endocrine / Q000639:trends; D005260:Female; D006130:Growth Disorders / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D013007:Growth Hormone-Releasing Hormone / Q000032:analysis; D019382:Human Growth Hormone / Q000172:deficiency* / Q000627:therapeutic use; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology; D008297:Male; D008875:Middle Aged; D010900:Pituitary Diseases / Q000150:complications / Q000175:diagnosis; D011159:Population Surveillance / Q000379:methods; D011364:Professional Practice / Q000639:trends*
chemical_list: D019382:Human Growth Hormone; D013007:Growth Hormone-Releasing Hormone; D001120:Arginine