title: Does growth hormone replacement therapy reduce mortality in adults with growth hormone deficiency? Data from the Dutch National Registry of Growth Hormone Treatment in adults.
abstract: BACKGROUND
  Adults with GH deficiency (GHD) have a decreased life expectancy. The effect of GH treatment on mortality remains to be established.
  
  
  OBJECTIVE
  This nationwide cohort study investigates the effect of GH treatment on all-cause and cause-specific mortality and analyzes patient characteristics influencing mortality in GHD adults.
  
  
  METHODS
  Patients in the Dutch National Registry of Growth Hormone Treatment in Adults were retrospectively monitored (1985-2009) and subdivided into treatment (n = 2229), primary (untreated, n = 109), and secondary control (partly treated, n = 356) groups.
  
  
  METHODS
  Standardized mortality ratios (SMR) were calculated for all-cause, malignancy, and cardiovascular disease (CVD) mortality. Expected mortality was obtained from cause, sex, calendar year, and age-specific death rates from national death and population counts.
  
  
  RESULTS
  In the treatment group, 95 patients died compared to 74.6 expected [SMR 1.27 (95% confidence interval, 1.04-1.56)]. Mortality was higher in women than in men. After exclusion of high-risk patients, the SMR for CVD mortality remained increased in women. Mortality due to malignancies was not elevated. In the control groups mortality was not different from the background population. Univariate analyses demonstrated sex, GHD onset, age, and underlying diagnosis as influencing factors.
  
  
  CONCLUSIONS
  GHD men receiving GH treatment have a mortality rate not different from the background population. In women, after exclusion of high-risk patients, mortality was not different from the background population except for CVD. Mortality due to malignancies was not elevated in adults receiving GH treatment. Next to gender, the heterogeneous etiology is of influence on mortality in GHD adults with GH treatment.
authors.affiliation: Department of Internal Medicine, Section Endocrinology, VU University Medical Center, 1081 HV Amsterdam, The Netherlands. c.vanbunderen@vumc.nl
authors.forename: Christa C
authors.initials: CC
authors.lastname: van Bunderen
authors.forename: I Caroline
authors.initials: IC
authors.lastname: van Nieuwpoort
authors.forename: Lucia I
authors.initials: LI
authors.lastname: Arwert
authors.forename: Martijn W
authors.initials: MW
authors.lastname: Heymans
authors.forename: Anton A M
authors.initials: AA
authors.lastname: Franken
authors.forename: Hans P F
authors.initials: HP
authors.lastname: Koppeschaar
authors.forename: Aart J
authors.initials: AJ
authors.lastname: van der Lely
authors.forename: Madeleine L
authors.initials: ML
authors.lastname: Drent
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D002561:Cerebrovascular Disorders / Q000401:mortality; D005260:Female; D013006:Growth Hormone / Q000172:deficiency* / Q000627:therapeutic use*; D020249:Hormone Replacement Therapy; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009369:Neoplasms / Q000401:mortality; D009426:Netherlands / Q000453:epidemiology; D011994:Recombinant Proteins / Q000627:therapeutic use; D012042:Registries; D012307:Risk Factors
chemical_list: D011994:Recombinant Proteins; D013006:Growth Hormone