Effect of long-term untreated GH deficiency (GHD) and nine years of GH replacement on the quality of life (QoL) of GHD adults
FJ Gilchrist, RD Murray & SM Shalet
Background: In GHD adults short-term studies of GH replacement have been reported to improve several aspects of quality of life, in particular energy levels. Only one study to date has examined whether this beneficial effect on QoL is maintained on long-term replacement of greater than five years. Patients & Methods: In 1992 six-twelve months GH replacement was offered to severely GHD adults as part of a randomised placebo controlled study. At baseline 86 patients agreed to complete the Nottingham Health profile (NHP) (n=86) or both the NHP and Psychological General Well-Being Schedule (PGWB) (n=53) self rating questionnaires. At completion of this study the patients were given the option to continue GH replacement. Nine years later we attempted to contact all 86 patients involved in the study and asked them to complete the respective questionnaires once again. Replies from 54 patients were obtained. Results: The NHP showed a significant improvement in energy levels in the patients who remained on GH replacement (n=16) over the nine year period (50±33.6 vs 24.9±31.8; P=0.015). In those patients who did not undertake further GH replacement since the original trial (n=24) a significant deterioration from baseline in the NHP total score (2.63±3.4 vs 4.5±6.28; P=0.03); and the sleep (8.51±13.7 vs 17.48±21.1; P=0.043) and physical mobility (2.54±5.7 vs 9.18±17.43; P=0.042) subsections was observed. In the patients on GH replacement the PGWB questionnaire showed a significant improvement (n=10) in the vitality subsection (7.7±2.41 vs 12.5±3.24; P=0.003. Those patients who had not received GH since the completion of the original study (n=19) showed significant decreases in the well being (14.79±3.77 vs 13.47±3.75; P=0.048) and general health (11.58±2.46 vs 10.0±3.61; P=0.044) subsections. The change in the energy (NHP) and vitality (PGWB) subsection scores that occurred over the nine years of the study were significantly different between the patients who continued GH, and those who did not (P=0.002 & P=0.001 respectively). Conclusion: The beneficial effect of GH on QoL in GHD adults is maintained long-term, and contrasts with the decline in QoL that occurs in the untreated state. In keeping with the findings of short term studies of GH on the QoL of GHD adults, the greatest effect was observed in energy levels.