An audit of growth hormone replacement for GH-deficient adults in Scotland.
OBJECTIVE
Guidelines on the clinical use of growth hormone therapy in adults were issued by the UK National Institute for Clinical Excellence (NICE) in August 2003. We conducted a retrospective clinical audit on the use of growth hormone (GH) in Scotland to evaluate the use of these guidelines and their impact on clinical practice. The audit had two phases. In phase I, the impact of NICE criteria on specialist endocrine practice in starting and continuing GH replacement was assessed. In phase II, the reasons why some adults in Scotland with growth hormone deficiency were not on replacement therapy were evaluated.


METHODS
A retrospective cross-sectional case note review was carried out of all adult patients being followed up for growth hormone deficiency during the study period (1 March 2005 to 31 March 2008). Phase I of the audit included 208 patients and phase II 108 patients.


RESULTS
Sellar tumours were the main cause of GH deficiency in both phases of the audit. In phase I, 53 patients (77%) had an AGHDA-QoL score >11 documented before commencing GH post-NICE guidance, compared with 35 (25%) pre-NICE guidance. Overall, only 39 patients (18%) met the full NICE criteria for starting and continuing GH (pre-NICE, 11%; post-NICE, 35%). Phase II indicated that the main reasons for not starting GH included perceived satisfactory quality of life (n = 47, 43%), patient reluctance (16, 15%) or a medical contraindication (16, 15%).


CONCLUSIONS
Although the use of quality of life assessments has increased following publication of the NICE guidelines, most adults on GH in Scotland did not fulfil the complete set of NICE criteria. The main reason for not starting GH therapy in adult GH-deficient patients was perceived satisfactory quality of life.
Aberdeen Royal Infirmary, Aberdeen, UK. sam.philip@nhs.net
Sam
S
Philip
Isobel
I
Howat
Maggie
M
Carson
Anne
A
Booth
Karen
K
Campbell
Donna
D
Grant
Catherine
C
Patterson
Christopher
C
Schofield
John
J
Bevan
Alan
A
Patrick
Graham
G
Leese
John
J
Connell
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D054869:Clinical Audit; D003430:Cross-Sectional Studies; D004393:Dwarfism, Pituitary / Q000188:drug therapy / Q000453:epidemiology; D019983:Guideline Adherence / Q000706:statistics & numerical data; D020249:Hormone Replacement Therapy; D019382:Human Growth Hormone / Q000172:deficiency* / Q000627:therapeutic use*; D006801:Humans; D007018:Hypopituitarism / Q000188:drug therapy* / Q000453:epidemiology; D008875:Middle Aged; D012189:Retrospective Studies; D012606:Scotland / Q000453:epidemiology; D055815:Young Adult
D019382:Human Growth Hormone