Endocrine Abstracts

OBJECTIVE: To determine whether the quality of life improvement, observed with long-term physiological GH replacement, is correlated with favourable changes in body composition or total body water (TBW) measured by direct methods.

METHODS: Thirty (16 female, age range 17-65 years) severely GHD adults were studied. Patients with diabetes insipidus, cardiovascular or renal disease requiring diuretic therapy were excluded. Patients with additional pituitary deficits had received stable conventional replacement for at least six months.

Data from 2 self-rating questionnaires, the PGWB (generic, 6 domains; lower score-worse QOL) and AGHDA (disease generated; higher score-worse QOL) were studied.

Dose titration of GH against age-adjusted IGF-I SDS was utilised to minimise risk of non-physiological replacement. QOL, body composition assessed by DEXA and TBW measured by deuterium dilution were studied at baseline, and at 3 and 6 months of GH replacement.

RESULTS: Median age adjusted IGF-I SDS increased from -3.40 (-6.40 to -1.60) to -0.2 (-1.88 to 0.775), (p<0.0001) at 6 months (median daily GH dose of 0.364mg). PGWB score increased from 62.9 ± 3.83 to 73.3 ± 4.10 (p = 0.0006). AGHDA score decreased from 13.69 ± 1.35 to 8.75 ± 1.47 (p = 0.0002).

LBM increased from (baseline) 47 ± 1.96kg to 49.51 ± 2.04kg (p=0.0008), fat mass (FM) decreased from (baseline) 27.99 ± 2.21kg to 27.16 ± 2.38kg (p=0.0004), and there was a non-significant median increase in TBW of 1.7kg (p=0.08). No correlations were demonstrated between QOL scores and body composition variables or QOL and TBW, measured by direct methods, at any time point during the study.

CONCLUSIONS: Physiological GH replacement induces significant improvements in QOL in severely GHD adults. The mechanism for QOL improvement in severely GHD adults during this treatment remains unclear but is not related to the observed, favourable changes in body composition.