title: Non-functioning pituitary macroadenomas: Benefit from early growth hormone substitution after surgery.
abstract: OBJECTIVE
  Data suggests that substitution of GH in GH-deficient patients may improve quality-of-life and reduce insufficiency-associated-symptoms. Unlike in corticotroph, thyreotroph, or gonadotroph-insufficiency, GH-substitution is usually not started within the first 6-12months after surgery. We aimed to investigate the effect of early-GH-substitution on body-composition, metabolic and pituitary-laboratory-tests, and quality-of-life.
  
  
  METHODS
  Data was reviewed from 21 adult-patients who were diagnosed with insufficiency of GH-axis using insulin-hypoglycemia-test. We retrospectively assessed body-composition, metabolic and pituitary-laboratory-tests and quality-of-life for a period of 52-weeks after pituitary-surgery in patients with early GH-substitution (= treated-group, 11-patients) and no GH-substitution (= untreated group, 10-patients).
  
  
  RESULTS
  Follow-up-IGF-I-levels of the treated-group stayed within the normal range and differed significantly from the untreated-group. Bioelectrical-impedance-analysis showed a significant decrease of impedance, a significant increase of lean-body-mass and a significant difference in health status in the treated group (p<0.05). Average increase in HDL-level was 2.1mg/dl in the untreated compared to an average decrease of 0.2mg/dl in the treated-group. Lp(a)-levels were reduced by 4.1mg/dl in the treated and by 2.7mg/dl in the untreated-group. Both groups showed an initial-mean-life-satisfaction below average (-0.9 and -1.2). Within one year after surgery mean-health-status improved in both groups. The difference in health-status after 1-year compared to the health-status of the previous year was statistically different between both groups with a greater benefit in the treated-group. Finally there was a trend detectably pointing towards an improvement in pituitary-function (LH- and FSH-recovery) if GH was substituted.
  
  
  CONCLUSIONS
  Early GH-substitution leads to a significant improvement in quality-of-life and body-composition after pituitary-surgery. It is possible that pituitary-function recovers more with early-GH-substitution.
authors.affiliation: Universitätsklinikum Hamburg-Eppendorf Interdisziplinäre Endokrinologie/Hypophysenchirurgie, Martinistr. 52, 20246 Hamburg, Germany. Electronic address: ni.sauer@uke.de.
authors.forename: Nina
authors.initials: N
authors.lastname: Sauer
authors.affiliation: Universitätsklinikum Hamburg-Eppendorf Interdisziplinäre Endokrinologie/Hypophysenchirurgie, Martinistr. 52, 20246 Hamburg, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Flitsch
authors.affiliation: Universitätsklinikum Hamburg-Eppendorf Interdisziplinäre Endokrinologie/Hypophysenchirurgie, Martinistr. 52, 20246 Hamburg, Germany.
authors.forename: Inga
authors.initials: I
authors.lastname: Doeing
authors.affiliation: Universitätsklinikum Hamburg-Eppendorf Interdisziplinäre Endokrinologie/Hypophysenchirurgie, Martinistr. 52, 20246 Hamburg, Germany.
authors.forename: Viola
authors.initials: V
authors.lastname: Dannheim
authors.affiliation: Universitätsklinikum Hamburg-Eppendorf Interdisziplinäre Endokrinologie/Hypophysenchirurgie, Martinistr. 52, 20246 Hamburg, Germany.
authors.forename: Till
authors.initials: T
authors.lastname: Burkhardt
authors.affiliation: Universitätsklinikum Hamburg-Eppendorf Interdisziplinäre Endokrinologie/Hypophysenchirurgie, Martinistr. 52, 20246 Hamburg, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Aberle
mesh_terms: D000236:Adenoma / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D017024:Chemotherapy, Adjuvant; D005260:Female; D020249:Hormone Replacement Therapy; D019382:Human Growth Hormone / Q000172:deficiency* / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D011184:Postoperative Period; D011788:Quality of Life; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D047368:Tumor Burden; D014938:Work Capacity Evaluation
chemical_list: D019382:Human Growth Hormone
keywords: Benefit of health status; Growth hormone substitution; Metabolic benefit; Pituitary macroadenoma; Pituitary recovery