Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2009) 19 P243

SFEBES2009 Poster Presentations Pituitary (56 abstracts)

Growth hormone deficiency in adults: the NICE criteria do not discriminate an adverse cardiovascular phenotype

Aurora Aragon Alonso 1 , Mark Sherlock 1 , Elizabeth McGregor 1 , Robert Murray 2 , Paul M Stewart 1 & Andrew A Toogood 1

1Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; 2Department of Endocrinology, Leeds Teaching Hospitals NHS Trust, D Floor, Brotherton Wing, Leeds General Infirmary, Leeds, UK.

Severe growth hormone (GH) deficiency in adults is associated with adverse changes in quality of life (QoL), body composition and cardiovascular risk profile. NICE guidance restricts GH replacement in the UK to those with impaired QoL, defined by a score of >11 in the QoL-AGHDA questionnaire.

Aims: To assess whether the NICE guidance differentiates other clinical or biochemical features in GH deficient adults.

Patients and methods: Fifty three GH deficient adults (19 female, median age 46 years) were divided into two groups determined by their response to the QoL-AGHDA, <11 or ≥11. Markers of cardiovascular risk and body composition parameters were determined.

Results: The QoL-AGHDA score was ≥11 in 30/53 (56.6%). The groups were matched for age, gender, severity of GH deficiency, degree of hypopituitarism and frequency of radiotherapy. Of the parameters measured only serum triglycerides differed between the two groups (Table 1).

QoL-AGHDA scoreP
Median (IQR)
IGF-I levels (nmol/l)14 (9–17)17 (11–19)0.39
fT4 (pmol/l)14 (13–17)14 (13–16)0.71
11β-HSD1 activity (THF+alloTHF/THE ratio)1.4 (1–1.8)1.2 (0.8–1.8)0.33
Total cholesterol (mmol/l)5.6 (4.8–6.6)4.8 (4.6–5.5)0.18
HDL cholesterol (mmol/l)1.5 (1.2–1.8)1.5 (1.2–1.6)0.15
Triglycerides (mmol/l)1.6 (1.2–2.7)1.1 (0.8–1.9)0.02
Lipoprotein (a)143 (77–271)270 (111–644)0.12
Carotid intima media thickness (mm)0.64 (0.56–0.81)0.65 (0.58–0.73)0.45
BMI (kg/m2)29 (25–35)29 (27–32)0.16
Fat mass (kg)29 (19–41)25 (18–33)0.1
Fat free mass (kg)60 (51–65)61 (53–65)0.25
WHR0.9 (0.9–1)0.9 (0.9–1)0.67

Conclusion: Quality of life does not determine the phenotype of adults with severe GH deficiency. Patients who do not fulfil the NICE criteria have similar changes in body composition and markers of cardiovascular risk. Selection of patients for GH replacement based on NICE criteria of QoL may deny a large cohort of patients the beneficial cardiovascular effects of GH.

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