Endocrine Abstracts (2009) 20 P547

Effects of 3 years growth hormone (GH) replacement in adult-onset growth hormone deficiency (GHD) due to controlled Cushing's disease (CD)

Charlotte Hoybye1, Peter J Jonsson2, Ulla Feldt-Rasmussen3, Oskar Ragnarsson4, Peter Trainer5, Beverly Biller6 & Maria Koltowska-Haggstrom2

1Department of Endocrinology, Metabolism and Diabetology, Karolinska University Hospital, Stockholm, Sweden; 2KIMS Medical Outcomes, Pfizer Endocrine Care, Sollentuna, Sweden; 3Department of Medical Endocrinology, Rigshospitalet, Copenhagen, Denmark; 4Sahlgrenska University Hospital, Gothenburg, Sweden; 5Department of Endocrinology, Christie Hospital, Manchester, UK; 6Neuroendocrine Unit, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA.

Objective: Our study evaluates the contribution of untreated GHD to the phenotype in controlled CD, by comparing patients with GHD due to CD (n=322) and those with non-functioning pituitary adenoma (NFPA n=748) before and after 3 years of GH treatment.

Methods: The patient cohorts were obtained from KIMS (Pfizer International Metabolic Database) and matched for age and gender. Duration between pituitary disease onset and GH start was 9.7 (CD) and 6.6 years (NFPA) (P<0.001).

Results: At baseline, there were no differences in IGF-I SDS, BMI, body composition, triglycerides or HDL-cholesterol. Total cholesterol (5.7±1.17 mmol/l vs 5.9±1.23 (P<0.05)), LDL-cholesterol (3.5±1.03 mmol/l vs 3.8±1.09 (P<0.01)), glucose (4.7±1.21 mmol/l vs 4.8±0.97 (P<0.01)) were more favourable in CD than NFPA. QoL-AGHDA (14.6±6.64 vs 11.3±7.57 (P<0.001)) indicated poorer quality of life (QoL) in patients with CD. The mean starting GH dose was 0.22 mg/day in both groups; maintenance doses were 0.39 (CD) and 0.37 mg/day (NFPA). Mean IGF-I SDS increased similarly (by ~2 SDS).

After 3 years of GH, BMI increased only in CD (0.3±3.9 kg/m2 P<0.01) while waist circumference decreased only in NFPA (−1.2±6.6 cm P<0.001). There was a reduction in total (−0.6±1.2; −0.5±1.1 P<0.001) and LDL-cholesterol (−0.6±1.0; −0.5±0.9 P<0.001) in CD and NFPA, respectively, while HDL-cholesterol and triglycerides were unchanged. Glucose and HbA1C increased similarly in both groups (P<0.001). Improvement in QoL (a decrease in QoL-AGHDA scores) was observed in both groups (−6±6 in CD and −5±6 in NFPA), with greater improvement in the CD group (P<0.01). No other changes were significantly different between the groups.

Conclusions: Patients with CD and GHD had better metabolic profile and poorer QoL than those with NFPA before GH replacement and experienced greater QoL improvement with GH treatment. Untreated GHD may contribute to the phenotype of controlled CD.

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