Elderly people with hypothalamic-pituitary disease and untreated growth hormone deficiency: Clinical outcome, body composition, lipid profiles and quality of life after 2 years compared to controls
JSW Li Voon Chong1, T Groves1, P Foy2, ME Wallymahmed1 & IA MacFarlane1
OBJECTIVE: To assess the impact of untreated growth hormone deficiency (GHD) over 2 yrs in elderly patients with hypothalamic-pituitary disease. Controls were also followed for 2 yrs.
SUBJECTS: 27 patients (>65 yrs) with GHD (mean) peak stimulated GH 1.6 mIU/l(range 0.6-5)were initially studied. Two yrs later 21(13 males) agreed to attend for reassessment. 27 controls (>65 y) were studied at baseline and 17 (7 males) agreed to attend for reassessment.
METHODS: BMI, total Fat Mass (FM) (bioelectrical impedance), serum IGF-1, fasting lipid profile and QOL were measured.
RESULTS: Mean (SD). Two of the 27 patients with GHD died during the 2-year follow-up. 4 controls could not be traced but there were no deaths in the other 23. In the 21 GHD patients after 2 yrs, serum IGF-1 and BMI were unchanged:12.6 (5.8) v 13.3 (5.1) nmol/l (p=0.5) and 28.3 (4.3) v 29.1(4.2) (p=0.5) at 2 yr follow-up and there were no significant changes in the lipid profiles. However there was a significant reduction in FM: 31.7 (11.2) v 28.5 (10.9)% (p=0.04). In the 17 controls after 2 yrs, IGF-1 BMI and FM were unchanged. However there was a significant fall in total cholesterol levels over the 2 yr follow up: 6.3 (0.9) v 5.7 (0.9) mmol/l (p=<0.0001), although LDL cholesterol, triglycerides and HDL cholesterol were unchanged. Analysing the QOL data, the GHD patients had less energy, more depression, more pain and worse life fulfilment scores after 2 yrs. However the control subjects also had less energy, vitality and self esteem, more depression, worse mental health, life fulfilment personal, life fulfilment material, physical functioning and role physical functioning after 2 yrs.
CONCLUSION: These results raise doubts about the benefits of GH replacement in elderly people with GHD.