title: From isolated GH deficiency to multiple pituitary hormone deficiency: an evolving continuum - a KIMS analysis.
abstract: OBJECTIVE
  To describe baseline clinical presentation, treatment effects and evolution of isolated GH deficiency (IGHD) to multiple pituitary hormone deficiency (MPHD) in adult-onset (AO) GHD.
  
  
  METHODS
  Observational prospective study.
  
  
  METHODS
  Baseline characteristics were recorded in 4110 patients with organic AO-GHD, who were GH naïve prior to entry into the Pfizer International Metabolic Database (KIMS; 283 (7%) IGHD, 3827 MPHD). The effect of GH replacement after 2 years was assessed in those with available follow-up data (133 IGHD, 2207 MPHD), and development of new deficiencies in those with available data on concomitant medication (165 IGHD, 3006 MPHD).
  
  
  RESULTS
  IGHD and MPHD patients had similar baseline clinical presentation, and both groups responded similarly to 2 years of GH therapy, with favourable changes in lipid profile and improved quality of life. New deficiencies were observed in 35% of IGHD patients, which was similar to MPHD patients with one additional deficit other than GH. New deficiencies most often presented within the first year but were observed up to 6 years after GH commencement. Conversion of IGHD into MPHD was not predicted by aetiology, baseline characteristics, surgery or radiotherapy, whereas in MPHD additional deficits were predicted by age (P<0.001) and pituitary disease duration (P<0.01).
  
  
  CONCLUSIONS
  Both AO-IGHD and -MPHD patients have similar baseline clinical presentation and respond equally well to 2 years of GH replacement. Hypopituitarism in adults seems to be a dynamic condition where new deficiencies can appear years after the initial diagnosis, and careful endocrine follow-up of all hypopituitary patients, including those with IGHD, is warranted.
authors.affiliation: Department of Medical Endocrinology, Copenhagen University Hospital, Rigshospitalet, Denmark. klose@rh.dk
authors.forename: M
authors.initials: M
authors.lastname: Klose
authors.forename: B
authors.initials: B
authors.lastname: Jonsson
authors.forename: R
authors.initials: R
authors.lastname: Abs
authors.forename: V
authors.initials: V
authors.lastname: Popovic
authors.forename: M
authors.initials: M
authors.lastname: Koltowska-Häggström
authors.forename: B
authors.initials: B
authors.lastname: Saller
authors.forename: U
authors.initials: U
authors.lastname: Feldt-Rasmussen
authors.forename: I
authors.initials: I
authors.lastname: Kourides
mesh_terms: D000328:Adult; D017668:Age of Onset; D003397:Craniopharyngioma / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D016208:Databases, Factual; D005260:Female; D019382:Human Growth Hormone / Q000172:deficiency* / Q000627:therapeutic use*; D006801:Humans; D007018:Hypopituitarism / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010907:Pituitary Hormones / Q000172:deficiency* / Q000627:therapeutic use; D010911:Pituitary Neoplasms / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors
chemical_list: D010907:Pituitary Hormones; D019382:Human Growth Hormone