From isolated GH deficiency to multiple pituitary hormone deficiency: an evolving continuum - a KIMS analysis.

Abstract

OBJECTIVE:

To describe baseline clinical presentation, treatment effects and evolution of isolated GH deficiency (IGHD) to multiple pituitary hormone deficiency (MPHD) in adult-onset (AO) GHD.

DESIGN:

Observational prospective study.

METHODS:

Baseline characteristics were recorded in 4110 patients with organic AO-GHD, who were GH naïve prior to entry into the Pfizer International Metabolic Database (KIMS; 283 (7%) IGHD, 3827 MPHD). The effect of GH replacement after 2 years was assessed in those with available follow-up data (133 IGHD, 2207 MPHD), and development of new deficiencies in those with available data on concomitant medication (165 IGHD, 3006 MPHD).

RESULTS:

IGHD and MPHD patients had similar baseline clinical presentation, and both groups responded similarly to 2 years of GH therapy, with favourable changes in lipid profile and improved quality of life. New deficiencies were observed in 35% of IGHD patients, which was similar to MPHD patients with one additional deficit other than GH. New deficiencies most often presented within the first year but were observed up to 6 years after GH commencement. Conversion of IGHD into MPHD was not predicted by aetiology, baseline characteristics, surgery or radiotherapy, whereas in MPHD additional deficits were predicted by age (P<0.001) and pituitary disease duration (P<0.01).

CONCLUSION:

Both AO-IGHD and -MPHD patients have similar baseline clinical presentation and respond equally well to 2 years of GH replacement. Hypopituitarism in adults seems to be a dynamic condition where new deficiencies can appear years after the initial diagnosis, and careful endocrine follow-up of all hypopituitary patients, including those with IGHD, is warranted.

• Authors: M Klose, B Jonsson, R Abs, V Popovic, M Koltowska-Häggström, B Saller, U Feldt-Rasmussen, I Kourides
• Journal: European journal of endocrinology (Eur J Endocrinol) Vol. 161 Suppl 1 Pg. S75-83 (Nov 2009) ISSN: 1479-683X [Electronic] England
• PMID: 19684053 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Pituitary Hormones
• Human Growth Hormone

Topics

• Adult
• Age of Onset
• Craniopharyngioma (radiotherapy, surgery, therapy)
• Databases, Factual
• Female
• Human Growth Hormone (deficiency, therapeutic use)
• Humans
• Hypopituitarism (drug therapy, etiology, metabolism)
• Male
• Middle Aged
• Pituitary Hormones (deficiency, therapeutic use)
• Pituitary Neoplasms (radiotherapy, surgery, therapy)
• Prospective Studies
• Risk Factors
• Time Factors