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Ricci Bitti S, Franco M, Albertelli M, Gatto F, Vera L, Ferone D, Boschetti M. GH Replacement in the Elderly: Is It Worth It? Front Endocrinol (Lausanne) 2021; 12:680579. [PMID: 34211437 PMCID: PMC8239420 DOI: 10.3389/fendo.2021.680579] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 06/02/2021] [Indexed: 11/24/2022] Open
Abstract
Growth hormone (GH), once the age of linear growth is completed, continues to play a fundamental role for the human body. In adulthood, GH contributes to regulate muscle, cardiovascular and bone metabolism. The same happens in old age, although there is less data on the effect of GH in the elderly. Regardless the age of onset, a reduced quality of life (QoL), an increased cardiovascular risk and an accelerated age-related decline in physical strength have been demonstrated in the elderly with GH deficiency (EGHD). In adults with GH deficiency (AGHD), recent studies suggest a role of GH replacement therapy (GHrt) in improving lean/fat mass ratio, blood pressure, lipid profile, bone metabolism and QoL. Despite these recent studies, there is still a lack of randomized controlled trials proving these positive effects in EGHD. Moreover, the lack of a long-term positive outcome on mortality, and the cost of GHrt could often impact on treatment decision-making and lead to postpone or avoid the prescription. The aim of this mini-review is to summarize the available data on GHrt in EGHD, in order to highlight its weaknesses and strengths and to provide directions to clinicians that will help in the management of this specific set of patients.
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Affiliation(s)
- Silvia Ricci Bitti
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties, School of Medical and Pharmaceutical Sciences, University of Genova, Genova, Italy
| | - Marta Franco
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties, School of Medical and Pharmaceutical Sciences, University of Genova, Genova, Italy
| | - Manuela Albertelli
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties, School of Medical and Pharmaceutical Sciences, University of Genova, Genova, Italy
- Endocrinology Unit, IRCCS Policlinico San Martino, Genova, Italy
| | - Federico Gatto
- Endocrinology Unit, IRCCS Policlinico San Martino, Genova, Italy
| | - Lara Vera
- Endocrinology Unit, IRCCS Policlinico San Martino, Genova, Italy
| | - Diego Ferone
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties, School of Medical and Pharmaceutical Sciences, University of Genova, Genova, Italy
- Endocrinology Unit, IRCCS Policlinico San Martino, Genova, Italy
| | - Mara Boschetti
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties, School of Medical and Pharmaceutical Sciences, University of Genova, Genova, Italy
- Endocrinology Unit, IRCCS Policlinico San Martino, Genova, Italy
- *Correspondence: Mara Boschetti,
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Gardner CJ, Mattsson AF, Daousi C, Korbonits M, Koltowska-Haggstrom M, Cuthbertson DJ. GH deficiency after traumatic brain injury: improvement in quality of life with GH therapy: analysis of the KIMS database. Eur J Endocrinol 2015; 172:371-81. [PMID: 25583905 DOI: 10.1530/eje-14-0654] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Prevalence of GH deficiency (GHD) caused by traumatic brain injury (TBI) is highly variable. Short-term studies show improvement in quality of life (QoL) during GH replacement (GHR), but long-term data are lacking. The aim of this study was to analyse the clinical characteristics of post-traumatic hypopituitarism and the QoL effects of long-term GHR. DESIGN/METHODS Pfizer International Metabolic Database patients with GHD caused by TBI and by non-functioning pituitary adenoma (NFPA) were compared regarding: clinical characteristics at baseline and 1-year of GHR, and QoL response up to 8-years of GHR (QoL-AGHDA total scores and dimensions) in relationship with country-specific norms. RESULTS TBI patients compared with NFPA patients were younger, diagnosed with GHD 2.4 years later after primary disease onset (P<0.0001), had a higher incidence of isolated GHD, higher GH peak, a more favourable metabolic profile and worse QoL, were shorter by 0.9 cm (1.8 cm when corrected for age and gender; P=0.004) and received higher GH dose (mean difference: 0.04 mg/day P=0.006). In TBI patients, 1-year improvement in QoL was greater than in NFPA (change in QoL-AGHDA score 5.0 vs 3.5, respectively, P=0.04) and was sustained over 8 years. In TBI patients, socialisation normalised after 1 year of GHR, self-confidence and tenseness after 6 years and no normalisation of tiredness and memory was observed. CONCLUSION Compared with NFPA, TBI patients presented biochemically with less severe hypopituitarism and worse QoL scores. GHR achieved clinically relevant, long-term benefit in QoL.
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Affiliation(s)
- Chris J Gardner
- Department of Obesity and EndocrinologyInstitute of Ageing and Chronic Disease, University of Liverpool, Liverpool L9 7AL, UKPfizer Endocrine CarePfizer, Inc., Sollentuna, SwedenBarts and the London School of Medicine and DentistryWilliam Harvey Research Institute, Centre for Endocrinology, Queen Mary University of London, London, UKDepartment of Women's and Children's HealthUppsala University, Uppsala, Sweden
| | - Anders F Mattsson
- Department of Obesity and EndocrinologyInstitute of Ageing and Chronic Disease, University of Liverpool, Liverpool L9 7AL, UKPfizer Endocrine CarePfizer, Inc., Sollentuna, SwedenBarts and the London School of Medicine and DentistryWilliam Harvey Research Institute, Centre for Endocrinology, Queen Mary University of London, London, UKDepartment of Women's and Children's HealthUppsala University, Uppsala, Sweden
| | - Christina Daousi
- Department of Obesity and EndocrinologyInstitute of Ageing and Chronic Disease, University of Liverpool, Liverpool L9 7AL, UKPfizer Endocrine CarePfizer, Inc., Sollentuna, SwedenBarts and the London School of Medicine and DentistryWilliam Harvey Research Institute, Centre for Endocrinology, Queen Mary University of London, London, UKDepartment of Women's and Children's HealthUppsala University, Uppsala, Sweden
| | - Márta Korbonits
- Department of Obesity and EndocrinologyInstitute of Ageing and Chronic Disease, University of Liverpool, Liverpool L9 7AL, UKPfizer Endocrine CarePfizer, Inc., Sollentuna, SwedenBarts and the London School of Medicine and DentistryWilliam Harvey Research Institute, Centre for Endocrinology, Queen Mary University of London, London, UKDepartment of Women's and Children's HealthUppsala University, Uppsala, Sweden
| | - Maria Koltowska-Haggstrom
- Department of Obesity and EndocrinologyInstitute of Ageing and Chronic Disease, University of Liverpool, Liverpool L9 7AL, UKPfizer Endocrine CarePfizer, Inc., Sollentuna, SwedenBarts and the London School of Medicine and DentistryWilliam Harvey Research Institute, Centre for Endocrinology, Queen Mary University of London, London, UKDepartment of Women's and Children's HealthUppsala University, Uppsala, Sweden
| | - Daniel J Cuthbertson
- Department of Obesity and EndocrinologyInstitute of Ageing and Chronic Disease, University of Liverpool, Liverpool L9 7AL, UKPfizer Endocrine CarePfizer, Inc., Sollentuna, SwedenBarts and the London School of Medicine and DentistryWilliam Harvey Research Institute, Centre for Endocrinology, Queen Mary University of London, London, UKDepartment of Women's and Children's HealthUppsala University, Uppsala, Sweden
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