title: The relationship between glucocorticoid replacement and quality of life in 2737 hypopituitary patients.
abstract: OBJECTIVE
  Quality of life (QoL) is impaired in hypopituitary patients and patients with primary adrenal insufficiency. The aim of this study was to analyse the impact of glucocorticoid (GC) replacement on QoL. The main hypothesis was that ACTH-insufficient patients experience a dose-dependent deterioration in QoL.
  
  
  METHODS
  This was a retrospective analysis of data from KIMS (Pfizer International Metabolic Database). Data from 2737 adult GH-deficient (GHD) hypopituitary patients were eligible for analysis. Thirty-six per cent were ACTH sufficient and 64% ACTH insufficient receiving a mean±s.d. hydrocortisone equivalent (HCeq) dose of 22.3±8.7 mg (median 20.0). QoL at baseline and 1 year after commencement of GH replacement was assessed by the QoL-assessment of GHD in adults.
  
  
  RESULTS
  At baseline, no significant difference in QoL was observed between ACTH-sufficient and -insufficient patients. Increasing HCeq dose was associated with worse QoL. Patients on HCeq≤10 mg had the best and patients receiving ≥25 mg demonstrated the poorest QoL. At 1 year of GH replacement, the improvement in QoL did not differ between ACTH-sufficient and -insufficient patients, and no association was observed between HCeq dose and QoL improvement.
  
  
  CONCLUSIONS
  Adult hypopituitary patients with untreated GHD receiving GC replacement have similar QoL as ACTH-sufficient patients. Among ACTH-insufficient patients, there is a dose-dependent association between increasing dose and impaired QoL. This association may be explained by supraphysiological GC exposure although it remains plausible that clinicians may have increased GC doses in order to address otherwise unexplained QoL deficits.
authors.affiliation: Department of EndocrinologyDiabetes and Metabolism, Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gröna Stråket 8, SE-413 45 Gothenburg, SwedenPfizer Endocrine CareSollentuna, SwedenWilliam Harvey Research InstituteCentre for Clinical Endocrinology, St Bartholomew's Hospital, Queen Mary, University of London, London, UKDepartment of Women's and Children's HealthUppsala University, Uppsala, Sweden oskar.ragnarsson@medic.gu.se.
authors.forename: Oskar
authors.initials: O
authors.lastname: Ragnarsson
authors.affiliation: Department of EndocrinologyDiabetes and Metabolism, Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gröna Stråket 8, SE-413 45 Gothenburg, SwedenPfizer Endocrine CareSollentuna, SwedenWilliam Harvey Research InstituteCentre for Clinical Endocrinology, St Bartholomew's Hospital, Queen Mary, University of London, London, UKDepartment of Women's and Children's HealthUppsala University, Uppsala, Sweden.
authors.forename: Anders F
authors.initials: AF
authors.lastname: Mattsson
authors.affiliation: Department of EndocrinologyDiabetes and Metabolism, Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gröna Stråket 8, SE-413 45 Gothenburg, SwedenPfizer Endocrine CareSollentuna, SwedenWilliam Harvey Research InstituteCentre for Clinical Endocrinology, St Bartholomew's Hospital, Queen Mary, University of London, London, UKDepartment of Women's and Children's HealthUppsala University, Uppsala, Sweden.
authors.forename: John P
authors.initials: JP
authors.lastname: Monson
authors.affiliation: Department of EndocrinologyDiabetes and Metabolism, Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gröna Stråket 8, SE-413 45 Gothenburg, SwedenPfizer Endocrine CareSollentuna, SwedenWilliam Harvey Research InstituteCentre for Clinical Endocrinology, St Bartholomew's Hospital, Queen Mary, University of London, London, UKDepartment of Women's and Children's HealthUppsala University, Uppsala, Sweden.
authors.forename: Helena
authors.initials: H
authors.lastname: Filipsson Nyström
authors.affiliation: Department of EndocrinologyDiabetes and Metabolism, Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gröna Stråket 8, SE-413 45 Gothenburg, SwedenPfizer Endocrine CareSollentuna, SwedenWilliam Harvey Research InstituteCentre for Clinical Endocrinology, St Bartholomew's Hospital, Queen Mary, University of London, London, UKDepartment of Women's and Children's HealthUppsala University, Uppsala, Sweden.
authors.forename: Ann-Charlotte
authors.initials: AC
authors.lastname: Åkerblad
authors.affiliation: Department of EndocrinologyDiabetes and Metabolism, Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gröna Stråket 8, SE-413 45 Gothenburg, SwedenPfizer Endocrine CareSollentuna, SwedenWilliam Harvey Research InstituteCentre for Clinical Endocrinology, St Bartholomew's Hospital, Queen Mary, University of London, London, UKDepartment of Women's and Children's HealthUppsala University, Uppsala, Sweden.
authors.forename: Maria
authors.initials: M
authors.lastname: Kołtowska-Häggström
authors.affiliation: Department of EndocrinologyDiabetes and Metabolism, Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gröna Stråket 8, SE-413 45 Gothenburg, SwedenPfizer Endocrine CareSollentuna, SwedenWilliam Harvey Research InstituteCentre for Clinical Endocrinology, St Bartholomew's Hospital, Queen Mary, University of London, London, UKDepartment of Women's and Children's HealthUppsala University, Uppsala, Sweden.
authors.forename: Gudmundur
authors.initials: G
authors.lastname: Johannsson
mesh_terms: D000224:Addison Disease / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D000236:Adenoma / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D000328:Adult; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D020249:Hormone Replacement Therapy; D006801:Humans; D007018:Hypopituitarism / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D011788:Quality of Life; D012189:Retrospective Studies
chemical_list: D005938:Glucocorticoids