title: Is GH dosing optimal in female patients with adult-onset GH deficiency? An analysis from the NordiNet®International Outcome Study.
abstract: OBJECTIVE
  To evaluate gender differences in GH dosing, IGF-I and cardiovascular risk markers in adults with GH deficiency (GHD).
  
  
  METHODS
  NordiNet®International Outcome Study (NCT00960128), a noninterventional, multicentre study, evaluates the long-term effectiveness and safety of Norditropin®(Novo Nordisk A/S) in the real-life clinical setting.
  
  
  METHODS
  Nondiabetic patients (n = 252; 41·7% female) with adult-onset GHD (age ≥20 years at GH start), ≥4 years' GH therapy and glycosylated haemoglobin (HbA1c) data at baseline and 4 years.
  
  
  METHODS
  Effects of gender (adjusted for baseline age and body mass index [BMI], average GH dose, treatment duration and concomitant medication) on change from baseline to 4 years (∆) in HbA1c, fasting plasma glucose (FPG), IGF-I, lipids and waist circumference were evaluated.
  
  
  RESULTS
  GH dose (mean [SE]; mg/day) was similar between females (0·22 [0·02]) and males (0·21 [0·01]) at baseline, but higher in females from year 1 (year 4, females, 0·45 [0·03]; males, 0·32 [0·02]). Mean IGF-I standard deviation score [SDS] was lower in females vs males at each treatment year; more than one-third of females still had an IGF-I SDS below 0 at year 4, compared with only 21·8% of men. An adverse lipid profile at baseline remained poor in more females than males at 4 years. Improvement in total cholesterol was significantly associated with gender (P < 0·0001), improving less in females than in males.
  
  
  CONCLUSIONS
  These data highlight that, even after 4 years, GH dose is suboptimal in many female patients, which may impact clinical outcomes; therefore, GH titration for women requires further improvement.
authors.affiliation: Department of Endocrinology, Metabolism and Diabetology, Karolinska University Hospital, Stockholm, Sweden.|Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.
authors.forename: Charlotte
authors.identifier: http://orcid.org/0000-0001-6412-166X
authors.initials: C
authors.lastname: Höybye
authors.affiliation: Department of Endocrinology and Metabolism, Medical Clinic, University of Mainz, Mainz, Germany.
authors.forename: Matthias M
authors.initials: MM
authors.lastname: Weber
authors.affiliation: Global Medical Affairs, Novo Nordisk Health Care AG, Zürich, Switzerland.
authors.forename: Effie
authors.initials: E
authors.lastname: Pournara
authors.affiliation: Epidemiology, Novo Nordisk A/S, Søborg, Denmark.
authors.forename: Birgitte
authors.initials: B
authors.lastname: Tønnes Pedersen
authors.affiliation: Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Beverly M K
authors.initials: BMK
authors.lastname: Biller
mesh_terms: D000328:Adult; D004305:Dose-Response Relationship, Drug; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D019382:Human Growth Hormone / Q000008:administration & dosage* / Q000172:deficiency*; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D008297:Male; D017063:Outcome Assessment, Health Care; D055815:Young Adult
chemical_list: D006442:Glycated Hemoglobin; D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I; C583557:IGF1 protein, human