Introduction: Guidelines for the use of GH in GH deficient adults were issued by the UK National Institute for Clinical Excellence (NICE). To assess current practice in relation to these guidelines, a review of patients receiving GH treatment was performed. The aims were to i) assess if adults with GH deficiency met NICE criteria for GH therapy and ii) identify reasons for initiating or continuing GH treatment if NICE criteria were not met.
Methods: Retrospective case note review of adults and young adults in transition receiving growth hormone therapy at the Nottingham Treatment Centre up to January 2015.
Results: Thirty-one patients (16 males and 15 females) were identified, mean age 45±15 years (S.D.). The majority (39%) of patients had previous pituitary surgery. Twenty-five patients were assessed as adults requiring GH replacement. 19 (76%) of these patients fulfilled all criteria for commencing GH therapy. 6 (24%) patients did not have tests to demonstrate severe GH deficiency but had convincing circumstantial clinical evidence of GH deficiency. 20 (80%) of patients were assessed with QOL-AGHDA questionnaire at baseline. 14 (56%) were reassessed within 12 months and met criteria to continue. The remaining 6 adult patients had childhood GH deficiency and continued treatment having fulfilled NICE guidance criteria.
Conclusion: There were patients who did not meet NICE criteria but had convincing evidence that justified GH treatment. The QOL-AGHDA questionnaire may have limitations given the subjective nature of questionnaires and comorbidities influencing quality of life. There may be a need to consider justifiable use of circumstantial clinical evidence based on clinical judgement and patients wishes when initiating and reassessing patients on GH treatment.