Changing patterns of the adult growth hormone deficiency diagnosis documented in a decade-long global surveillance database.
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.
Webb
Susan M
SM
Department of Endocrinology, Hospital Santa Creu i Sant Pau, Autonomous University of Barcelona, Pare Claret 167, 08025 Barcelona, Spain. swebb@santpau.cat
Strasburger
Christian J
CJ
Mo
Daojun
D
Hartman
Mark L
ML
Melmed
Shlomo
S
Jung
Heike
H
Blum
Werner F
WF
Attanasio
Andrea F
AF
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*
D019382:Human Growth Hormone; D013007:Growth Hormone-Releasing Hormone; D001120:Arginine