Background: National Institute for Clinical Excellence (NICE) guidelines for the use of Growth Hormone (GH) replacement in adults with GH deficiency (GHD) were published in 2003, and subsequently ratified for use in Scotland.
Aim: To identify all adults in Scotland currently receiving GH and to assess whether they meet the NICE criteria for starting and continuing GH replacement.
Methods: All endocrinologists in Scotland were surveyed to identify the main centres using GH replacement. An ongoing cross-sectional case note review is being undertaken of all patients started on GH, with the data entered into a customised database.
Results: This is an interim analysis of 98 patients (50% men; 28% professionals), 51 of whom started GH therapy after publication of the NICE criteria. Most were also taking other pituitary hormone replacements (thyroxine, 84%; hydrocortisone, 79%; testosterone, 61% men; oestrogens, 35% women; DDAVP, 20%). Insulin tolerance (52%) and glucagon stimulation (30%) were the most commonly used tests for confirming GH deficiency. Forty-five patients (46%) had an AGHDA score >11 documented before commencing GH 65% completed an AGHDA post-NICE compared with 26% pre-NICE. Only 18 patients (18%) met the full NICE criteria for starting and continuing GH (pre-NICE, 9%; post-NICE, 25%). Reasons stated for continuing GH therapy included improved quality of life (n=65), improved bone mineral density (5) and transitional benefit (5).
Conclusion: Although there is evidence of increased use of quality of life assessments post-NICE, the majority of Scottish patients do not satisfy the full NICE criteria for GH therapy. However, this is an interim analysis and the final number of patients is expected to exceed 220.