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Butler T, Harvey P, Cardozo L, Zhu YS, Mosa A, Tanzi E, Pervez F. Epilepsy, depression, and growth hormone. Epilepsy Behav 2019; 94:297-300. [PMID: 30773449 PMCID: PMC7980784 DOI: 10.1016/j.yebeh.2019.01.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 01/14/2019] [Accepted: 01/19/2019] [Indexed: 11/16/2022]
Abstract
Depression affects a large proportion of patients with epilepsy, and is likely due in part to biological mechanism. Hormonal dysregulation due to the disruptive effects of seizures and interictal epileptiform discharges on the hypothalamic-pituitary-adrenal axis likely contributes to high rates of depression in epilepsy. This paper reviews the largely unexplored role of neuroendocrine factors in epilepsy-related depression, focusing on Growth Hormone (GH). While GH deficiency is traditionally considered a childhood disorder manifested by impaired skeletal growth, GH deficiency in adulthood is now recognized as a serious disorder characterized by impairments in multiple domains including mood and quality of life. Could high rates of depression in patients with epilepsy relate to subtle GH deficiency? Because GH replacement therapy has been shown to improve mood and quality of life in patients with GH deficiency, this emerging area may hold promise for patients suffering from epilepsy-related depression.
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Affiliation(s)
- Tracy Butler
- Center for Brain Health, New York University School of Medicine, Department of Psychiatry, 145 East 32nd Street, New York, NY 10016, United States of America.
| | - Patrick Harvey
- Center for Brain Health, New York University School of Medicine, Department of Psychiatry, 145 East 32nd Street, New York, NY 10016, United States of America
| | - Lila Cardozo
- Center for Brain Health, New York University School of Medicine, Department of Psychiatry, 145 East 32nd Street, New York, NY 10016, United States of America
| | - Yuan-Shan Zhu
- Clinical and Translational Science Center, Weill Cornell Medicine, 1300 York Avenue, New York, NY 10065, United States of America
| | - Adam Mosa
- University of Toronto School of Medicine, Division of Plastic and Reconstructive Surgery, 149 College Street, 5th Floor, Suite 508, Toronto, Ontario M5T 1P5, Canada
| | - Emily Tanzi
- Center for Brain Health, New York University School of Medicine, Department of Psychiatry, 145 East 32nd Street, New York, NY 10016, United States of America
| | - Fahad Pervez
- Clinical and Translational Science Center, Weill Cornell Medicine, 1300 York Avenue, New York, NY 10065, United States of America
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Brod M, Beck JF, Højbjerre L, Bushnell DM, Adalsteinsson JE, Wilkinson L, Rasmussen MH. Assessing the Impact of Growth Hormone Deficiency (GHD) in Adults: Interpreting Change of the Treatment-Related Impact Measure-Adult Growth Hormone Deficiency (TRIM-AGHD). PHARMACOECONOMICS - OPEN 2019; 3:71-80. [PMID: 29797004 PMCID: PMC6393279 DOI: 10.1007/s41669-018-0082-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
BACKGROUND This study's purpose was to assess the minimal important difference (MID) for the Treatment-Related Impact Measure-Adult Growth Hormone Deficiency (TRIM-AGHD), a patient-reported outcome measure assessing growth hormone deficiency (GHD) impacts. The measure was demonstrated to have adequate psychometric measurement properties, and be reliable and valid. For scores to be interpretable, the TRIM-AGHD must be responsive to treatment benefit and the MID in scores quantified. METHODS A prospective, non-interventional, observational, clinic-based survey study of naïve-to-treatment adult GHD patients (N = 98) was conducted. Key assessments were at baseline and follow-up (between 4 and approximately 8 weeks), with weekly telephone monitoring post-baseline (last n = 34 patients). Responsiveness was evaluated using the effect size of change scores from baseline to follow-up. MID estimates were derived from distribution-based (half standard deviation [0.5 SD], standard error of measurement [SEm]) and anchor-based methods (patient global rating of change [PGRC]) using change scores from baseline to initial report of minimal improvement in GHD severity. Findings from each method were converged to establish an acceptable MID. RESULTS Patients were mean age 49.7 years, 65.6% female, and 76.0% Caucasian. The TRIM-AGHD was highly responsive to treatment with the total score effect size being 1.38. For the total score, the 0.5 SD was 8.09 and the SEm was 2.66. The difference found using the PGRC was 20.43. The converged MID value for the total score was 10 points. CONCLUSIONS The TRIM-AGHD is a highly responsive measure assessing AGHD treatment impacts. A 10-point change score is considered a clinically meaningful improvement.
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Affiliation(s)
- Meryl Brod
- The Brod Group, 219 Julia Avenue, Mill Valley, CA, 94941, USA.
| | - Jane F Beck
- The Brod Group, 219 Julia Avenue, Mill Valley, CA, 94941, USA
| | - Lise Højbjerre
- Novo Nordisk A/S, Vandtaarnsvej 114, 2860, Soeborg, Denmark
| | - Donald M Bushnell
- Health Research Associates, Inc, 6505 216th Street SW, Suite 105, Mountlake Terrace, WA, 98043, USA
| | | | - Lars Wilkinson
- Novo Nordisk A/S, Vandtaarnsvej 114, 2860, Soeborg, Denmark
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Xu J, Casserly E, Yin Y, Cheng J. A Systematic Review of Growth Hormone in Pain Medicine: From Rodents to Humans. PAIN MEDICINE 2019; 21:21-31. [PMID: 30615177 DOI: 10.1093/pm/pny280] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Abstract
Objective
Growth hormone (GH) and GH-related signaling molecules play an important role in nociception and development of chronic pain. This review aims to examine the potential molecular mechanisms through which GH-related signaling modulates sensory hypersensitivity in rodents, the clinical pharmacology of GH, and the clinical evidence of GH treatment for several common pain syndromes.
Methods
A search was conducted using the PUBMED/MEDLINE database, Scopus, and the Cochrane library for all reports published in English on GH in pain management from inception through May 2018. A critical review was performed on the mechanisms of GH-related signaling and the pharmacology of GH. The levels of clinical evidence and implications for recommendations of all of the included studies were graded.
Results
The search yielded 379 articles, of which 201 articles were deemed irrelevant by reading the titles. There were 53 reports deemed relevant after reading abstracts. All of these 53 articles were retrieved for the analysis and discussion.
Conclusions
Dysfunction of the GH/insulin-like growth factor 1 (IGF-1)/ghrelin axis was linked to hyperalgesia and several common clinical pain syndromes. Low levels of GH and IGF-1 were linked to pain hypersensitivity, whereas ghrelin appeared to provide analgesic effects. Pretreatment of GH reversed mechanical and thermal hypersensitivity in an animal model of inflammatory pain. Clinical trials support GH treatment in a subgroup of patients with fibromyalgia syndrome (level of evidence: 1B+) or chronic lower back pain syndrome (level of evidence: 2C+).
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Affiliation(s)
- Jijun Xu
- Department of Pain Management, Anesthesiology Institute
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Yan Yin
- Department of Pain Management, West China Hospital, Sichuan University, Chengdu, China
| | - Jianguo Cheng
- Department of Pain Management, Anesthesiology Institute
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Sonksen P. Determination and regulation of body composition in elite athletes. Br J Sports Med 2016; 52:219-229. [DOI: 10.1136/bjsports-2016-096742] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 10/04/2016] [Accepted: 10/23/2016] [Indexed: 11/04/2022]
Abstract
In 2011, the International Association of Athletics Federations (IAAF) and IOC introduced a ‘hyperandrogenism’ rule that excluded women with a serum testosterone >10 nmol/L from participating in elite sport. This rule was based on the false premise that the greater lean body mass in men was a consequence of their higher serum testosterone. This rule did not have scientific backing and the Court of Arbitration for Sport subsequently rescinded the rule following an appeal from an Indian athlete barred from the Commonwealth Games. This review covers the scientific knowledge about the development and regulation of body composition in humans but also considers the lessons learnt from evolution and breeding in animals. The importance of heredity has been documented in family and twin studies. The roles of growth hormone and sex steroids are reviewed. The Androgen Insensitivity Syndrome (AIS) is considered as a model of the role of testosterone in development of body composition and also as evidence of the importance of other factors carried on the Y-chromosome that are of prime importance but have been systematically ignored. Finally the key factors determining body composition are considered and placed in a suggested order of importance.
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Chikani V, Cuneo RC, Hickman I, Ho KKY. Growth hormone (GH) enhances anaerobic capacity: impact on physical function and quality of life in adults with GH deficiency. Clin Endocrinol (Oxf) 2016; 85:660-8. [PMID: 27346880 DOI: 10.1111/cen.13147] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 05/08/2016] [Accepted: 06/25/2016] [Indexed: 11/30/2022]
Abstract
CONTEXT Anaerobic capacity is impaired in adults with GH deficiency (GHD), adversely affecting physical function and quality of life (QoL). OBJECTIVE To investigate whether GH replacement improves anaerobic capacity, physical function and QoL in adults with GHD. DESIGN One-month double-blind placebo-controlled crossover study of GH (0·5 mg/day), followed by a 6-month open phase. PATIENTS A total of 18 adults with GHD. MEASUREMENTS Anaerobic power (watts) was assessed by the 30-s Wingate test, and aerobic capacity by the VO2 max (l/min) test. Physical functional was assessed by the stair climb test, chair stand test, 7-day pedometry and QoL by the AGHDA questionnaire. Lean body mass (LBM) was quantified by dual-energy X-ray absorptiometry. RESULTS GH replacement normalized IGF-1 levels during both study phases. During the 1-month placebo-controlled study, improvement in stair climb and chair stand performance was observed during GH and placebo treatment; however, there were no significant GH effects observed in any outcome measure compared to placebo. Six months of GH treatment significantly increased anaerobic power (P < 0·05), chair stand repetitions (P < 0·0001), daily step count (P < 0·05) and QoL scores (P < 0·001) compared to baseline measurements. GH treatment did not significantly improve VO2 max. Improvement in anaerobic power independently predicted an improvement in energy and vitality domain of QoL (P = 0·03). CONCLUSIONS GH replacement improves anaerobic capacity, physical function and QoL in a time-dependent manner in adults with GHD. Improvement in the anaerobic but not aerobic energy system is likely to underlie the improvement in QoL in patients with GHD during GH replacement.
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Affiliation(s)
- Viral Chikani
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Brisbane, Qld, Australia
- School of Medicine, University of Queensland, Brisbane, Qld, Australia
| | - Ross C Cuneo
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Ingrid Hickman
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Qld, Australia
- Mater Research Institute, University of Queensland, Brisbane, Qld, Australia
| | - Ken K Y Ho
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Brisbane, Qld, Australia.
- School of Medicine, University of Queensland, Brisbane, Qld, Australia.
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Appelman-Dijkstra NM, Rijndorp M, Biermasz NR, Dekkers OM, Pereira AM. Effects of discontinuation of growth hormone replacement in adult GH-deficient patients: a cohort study and a systematic review of the literature. Eur J Endocrinol 2016; 174:705-16. [PMID: 26944562 DOI: 10.1530/eje-15-1086] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 03/04/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Recombinant human growth hormone (rhGH) replacement is advocated in adult growth hormone-deficient (GHD) patients to increase bone mass and improve lipid profile, body composition, and quality of life. The long-term effects of discontinuation of rhGh replacement are unknown. METHODS This cohort study and systematic review aim to evaluate the long-term metabolic effects of discontinuation of rhGh replacement in adult GHD patients, with a subgroup analyses according to age (< or > 60 years). Data on anthropometry, lipids, glucose, and bone mass density (BMD) were assessed for 3 years after discontinuation. RESULTS Cohort study included 64 patients who had discontinued rhGh replacement for >12 months. Fat percentage increased from 31.5±9.5% to 33.8±9.0% (mean difference 2.3, P=0.003). BMI decreased only in subjects <60 years (P=0.014). Glucose, total cholesterol, and LDL-cholesterol levels did not change; however, the percentage of patients on statins increased slightly from 39% to 44%. HDL-C concentration increased only in patients <60 years (mean difference 0.2, P=0.043). Lumbar spine BMD did not change; however, femoral neck BMD and bone turnover markers decreased in subjects <60 years (P=0.001). Systematic review included eight studies (n=166 patients) with a follow-up duration of 6-18 months. Of the Please check the edit of the sentence 'Of the eight studies "'.eight studies, three qualified as low risk of bias and five as having an intermediate risk of bias. None of the studies reported handling of statins, bisphosphonates, and glucose-lowering medication or excluded patients using these medications. CONCLUSIONS In this study, discontinuation of rhGh replacement resulted in metabolic changes only in patients <60 years after 3 years. Further research warrants to determine the optimal strategies for (dis)continuation of rhGh replacement in adult patients with GHD.
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Affiliation(s)
- Natasha M Appelman-Dijkstra
- Department of MedicineDivision of Endocrinology and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, The Netherlands
| | - Marnick Rijndorp
- Department of MedicineDivision of Endocrinology and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, The Netherlands
| | - Nienke R Biermasz
- Department of MedicineDivision of Endocrinology and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, The Netherlands
| | - Olaf M Dekkers
- Department of MedicineDivision of Endocrinology and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, The Netherlands Department of Clinical EpidemiologyLeiden University Medical Center, Leiden, The Netherlands Department of Clinical EpidemiologyAarhus University, Aarhus, Denmark
| | - Alberto M Pereira
- Department of MedicineDivision of Endocrinology and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, The Netherlands
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Brod M, Pohlman B, Højbjerre L, Adalsteinsson JE, Rasmussen MH. Impact of adult growth hormone deficiency on daily functioning and well-being. BMC Res Notes 2014; 7:813. [PMID: 25406443 PMCID: PMC4255661 DOI: 10.1186/1756-0500-7-813] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 10/24/2014] [Indexed: 11/10/2022] Open
Abstract
Background Adult Growth Hormone Deficiency (AGHD) is a debilitating condition resulting from tumors, pituitary surgery, radiation of the head, head injury, or hypothalamic-pituitary disease. This qualitative study was conducted to better understand the multi-faceted impacts and treatment effects of GHD on adult patients’ daily lives. Seven focus groups and four telephone interviews were conducted in three countries. Eligible AGHD patients were age 22 or older who had started and stopped growth hormone treatment at least once as an adult. Transcripts were analyzed thematically. Results Thirty-nine patients were interviewed; majority etiology was pituitary disease or tumor (62%). Thirty-four patients (87%) were currently on growth hormone replacement therapy; therapy initiation mean age was 43 years. Analysis identified five domains of disease impact: 1) Psychological Health - changed body or self-image and negative emotional impacts; 2) Physical Health - problems with sleep/fatigue, sex drive, weight gain, hair, skin, muscle/bone loss; 3) Cognition - concentration or memory trouble; 4) Energy Loss and its negative impacts (productivity, exercise, chores, socialization, or motivation); and 5) Treatment Effect - treatment enhances quality of life, enabling patients to increase effort (exercise, chores, or work improvements). Energy and sleep are improved. Saturation of themes was reached after the sixth focus group. A conceptual model of GHD disease impacts was developed. Conclusions Untreated AGHD has significant negative impacts for patients, which treatment often improves. It is important for clinicians and researchers to understand these multiple impacts so that they can address them in individualized treatment plans and incorporate them when assessing treatment outcomes.
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Affiliation(s)
- Meryl Brod
- The Brod Group, 219 Julia Avenue, Mill Valley, CA 94941, USA.
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Abdi L, Sahnoun-Fathallah M, Morange I, Albarel F, Castinetti F, Giorgi R, Brue T. A monocentric experience of growth hormone replacement therapy in adult patients. ANNALES D'ENDOCRINOLOGIE 2014; 75:176-83. [DOI: 10.1016/j.ando.2014.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 05/05/2014] [Accepted: 05/13/2014] [Indexed: 10/25/2022]
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Brod M, Højbjerre L, Adalsteinsson JE, Rasmussen MH. Assessing the impact of growth hormone deficiency and treatment in adults: development of a new disease-specific measure. J Clin Endocrinol Metab 2014; 99:1204-12. [PMID: 24438372 DOI: 10.1210/jc.2013-3438] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
CONTEXT Approximately 50 000 adults in the United States are diagnosed with GH deficiency, which has negative impacts on cognitive functioning, psychological well-being, and quality of life. OBJECTIVE This paper presents development and validation of a patient-reported outcome measure (PRO), the Treatment-Related Impact Measure-Adult Growth Hormone Deficiency (TRIM-AGHD). The TRIM-AGHD was developed to measure the impact of GH deficiency and its treatment. DESIGN AND SETTINGS The development and validation of the TRIM-AGHD was conducted according to the Food and Drug Administration guidance on the development of PROs. Concept elicitation, conducted in three countries included interviews with patients, clinical experts, and literature review. Qualitative data were analyzed based on grounded theory principles, and draft items were cognitively debriefed. The measure underwent psychometric validation in a US clinic-based population. An a priori statistical analysis plan included assessment of the measurement model, reliability, and validity. Item functioning was reviewed using item response theory analyses. PATIENTS OR OTHER PARTICIPANTS Forty-eight patients and six clinical experts participated in concept elicitation and 169 patients completed the validation study. MAIN OUTCOME MEASURE TRIM-AGHD was measured. RESULTS Factor analysis resulted in four domains: energy level, physical health, emotional health, and cognitive ability. The item response theory confirmed adequate item fit and placement within their domain. Internal consistency ranged from 0.82 to 0.95 and test-retest ranged from 0.80 to 0.92. All prespecified hypotheses for convergent validity and all but two for discriminant validity were met. CONCLUSIONS The final 26-item TRIM-AGHD can be considered a reliable and valid PRO of the impact of disease and treatment for adult GH deficiency.
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Affiliation(s)
- Meryl Brod
- The Brod Group (M.B.), Mill Valley, California 94941; and Department of Global Development (L.H., J.E.A., M.H.R.), Novo Nordisk A/S, DK-2860 Søborg, Denmark
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Growth hormone response to catecholamine depletion in unmedicated, remitted subjects with major depressive disorder and healthy controls. J Clin Psychopharmacol 2013; 33:621-6. [PMID: 23963054 DOI: 10.1097/jcp.0b013e31829a8284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We investigated whether the human growth hormone (HGH) response to catecholamine depletion differs between fully remitted patients with major depressive disorder and healthy control subjects. Fourteen unmedicated subjects with remitted major depressive disorder (RMDD) and 11 healthy control subjects underwent catecholamine depletion with oral α-methylparatyrosine (AMPT) in a randomized, placebo-controlled, double-blind crossover study. The main outcome measure was the serum level of HGH. The diagnosis × drug interaction for HGH serum concentration was significant (F₁,₂₃ = 7.66, P < 0.02). This interaction was attributable to the HGH level increasing after AMPT administration in the RMDD subjects but not in the healthy subjects. In the RMDD sample, the AMPT-induced increase in HGH concentration correlated inversely with AMPT-induced anxiety symptoms as assessed using the Beck Anxiety Inventory (r = -0.63, P < 0.02). There was a trend toward an inverse correlation of the AMPT-induced HGH concentration changes with AMPT-induced depressive symptoms as measured by the BDI (r = -0.53, P = 0.05). Following catecholamine depletion, the RMDD subjects were differentiated from control subjects by their HGH responses. This finding, together with the negative correlation between HGH response and AMPT-induced anxiety symptoms in RMDD subjects, suggests that AMPT administration results in a deeper nadir in central catecholaminergic transmission, as reflected by a greater disinhibition of HGH secretion, in RMDD subjects versus control subjects.
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Filipsson Nyström H, Barbosa EJL, Nilsson AG, Norrman LL, Ragnarsson O, Johannsson G. Discontinuing long-term GH replacement therapy--a randomized, placebo-controlled crossover trial in adult GH deficiency. J Clin Endocrinol Metab 2012; 97:3185-95. [PMID: 22791760 DOI: 10.1210/jc.2012-2006] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
CONTEXT Adult GH deficiency (GHD) is associated with impaired quality of life (QoL) and increased cardiovascular risk. Continued long-term efficacy in terms of QoL and cardiovascular risk factors has been indicated in open surveillance studies. OBJECTIVES The aim was to study the impact of discontinuation of long-term GH replacement on QoL, body composition, and metabolism. DESIGN AND SETTING We conducted a randomized, double-blind, placebo-controlled 4-month crossover trial in a referral center. PATIENTS Sixty adult hypopituitary patients with GHD and more than 3 yr of continuous GH replacement therapy (mean treatment duration, 10 yr) participated in the study. INTERVENTION Patients received GH or placebo. MAIN OUTCOME MEASUREMENTS We measured QoL using validated questionnaires; body composition using computer tomography, dual-energy x-ray absorptiometry, and bioelectrical impedance spectroscopy; and insulin sensitivity using the short insulin tolerance test. RESULTS Mean serum IGF-I decreased from 168 ± 52 to 98 ± 47 μg/liter during the placebo period (P < 0.001). Two QoL domains (emotional reactions and positive well-being) in the Nottingham Health Profile and Psychological General Well-Being questionnaires deteriorated during placebo, compared with GH treatment (P < 0.05). Waist circumference and sc and visceral fat mass increased, and extracellular water and muscle area decreased during the placebo period (all P < 0.05). C-reactive protein and total-, low-density lipoprotein-, and high-density lipoprotein-cholesterol increased, and insulin sensitivity improved during placebo, compared to GH treatment (P < 0.05). CONCLUSION After more than 3 yr of GH replacement therapy, a 4-month period of placebo treatment caused self-perceived deterioration in QoL and increased abdominal fat accumulation. Moreover, markers of systemic inflammation and lipid status deteriorated, whereas insulin sensitivity improved. Long-term continuous GH replacement is needed to maintain therapeutic effects of GH on QoL and cardiovascular risk factors.
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Affiliation(s)
- Helena Filipsson Nyström
- Department of Endocrinology, Sahlgrenska University Hospital, and Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, SE-41345 Göteborg, Sweden.
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Giannoulis MG, Martin FC, Nair KS, Umpleby AM, Sonksen P. Hormone replacement therapy and physical function in healthy older men. Time to talk hormones? Endocr Rev 2012; 33:314-77. [PMID: 22433122 PMCID: PMC5393154 DOI: 10.1210/er.2012-1002] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Improving physical function and mobility in a continuously expanding elderly population emerges as a high priority of medicine today. Muscle mass, strength/power, and maximal exercise capacity are major determinants of physical function, and all decline with aging. This contributes to the incidence of frailty and disability observed in older men. Furthermore, it facilitates the accumulation of body fat and development of insulin resistance. Muscle adaptation to exercise is strongly influenced by anabolic endocrine hormones and local load-sensitive autocrine/paracrine growth factors. GH, IGF-I, and testosterone (T) are directly involved in muscle adaptation to exercise because they promote muscle protein synthesis, whereas T and locally expressed IGF-I have been reported to activate muscle stem cells. Although exercise programs improve physical function, in the long-term most older men fail to comply. The GH/IGF-I axis and T levels decline markedly with aging, whereas accumulating evidence supports their indispensable role in maintaining physical function integrity. Several studies have reported that the administration of T improves lean body mass and maximal voluntary strength in healthy older men. On the other hand, most studies have shown that administration of GH alone failed to improve muscle strength despite amelioration of the detrimental somatic changes of aging. Both GH and T are anabolic agents that promote muscle protein synthesis and hypertrophy but work through separate mechanisms, and the combined administration of GH and T, albeit in only a few studies, has resulted in greater efficacy than either hormone alone. Although it is clear that this combined approach is effective, this review concludes that further studies are needed to assess the long-term efficacy and safety of combined hormone replacement therapy in older men before the medical rationale of prescribing hormone replacement therapy for combating the sarcopenia of aging can be established.
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Affiliation(s)
| | - Finbarr C. Martin
- Guy's and St. Thomas' National Health Service Foundation Trust (F.C.M.), and Institute of Gerontology (F.C.M.), King's College, London WC2R 2LS, United Kingdom
| | | | - A. Margot Umpleby
- Department of Human Metabolism, Diabetes, and Metabolic Medicine (A.M.U.), Postgraduate Medical School, University of Surrey, Guildford GU2 7WG, United Kingdom
| | - Peter Sonksen
- St. Thomas' Hospital and King's College (P.S.), London SE1 7EW, United Kingdom; and Southampton University (P.S.), SO17 1BJ, Southampton, United Kingdom
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McKenna SP, Wilburn J, Twiss J, Crawford SR, Hána V, Karbownik-Lewinska M, Popovic V, Pura M, Koltowska-Häggström M. Adaptation of the QoL-AGHDA scale for adults with growth hormone deficiency in four Slavic languages. Health Qual Life Outcomes 2011; 9:60. [PMID: 21810234 PMCID: PMC3199740 DOI: 10.1186/1477-7525-9-60] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Accepted: 08/02/2011] [Indexed: 11/10/2022] Open
Abstract
PURPOSE The Quality of Life in Adult Growth Hormone Deficiency Assessment (QoL-AGHDA) is a disease-specific quality of life measure specific to individuals who are growth hormone deficient. The present study describes the adaptation of the QoL-AGHDA for use in the following four Slavic languages; Czech, Polish, Serbian and Slovakian. METHODS The study involved three stages in each language; translation, cognitive debriefing and validation. The validation stage assessed internal consistency (Cronbach's alpha), reproducibility (test-retest reliability using Spearman's rank correlations), convergent and divergent validity (Correlations with the NHP) and known group validity. RESULTS The QoL-AGHDA was successfully translated into the target languages with minimal problems. Cognitive debriefing interviewees (n = 15-18) found the measures easy to complete and identified few problems with the content. Internal consistency (Czech Republic = 0.91, Poland = 0.91, Serbia = 0.91 and Slovakia = 0.89) and reproducibility (Czech Republic = 0.91, Poland = 0.91, Serbia = 0.88 and Slovakia = 0.93) were good in all adaptations. Convergent and divergent validity and known group validity data were not available for Slovakia. The QoL-AGHDA correlated as expected with the NHP scales most relevant to GHD. The QoL-AGHDA was able to distinguish between participants based on a range of variables. CONCLUSIONS The QoL-AGHDA was successfully adapted for use in the Czech Republic, Poland, Serbia and Slovakia. Further validation of the Slovakian version would be beneficial. The addition of these new language versions will prove valuable to multinational clinical trials and to clinical practice in the respective countries.
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Kołtowska-Häggström M, Geffner ME, Jönsson P, Monson JP, Abs R, Hána V, Höybye C, Wollmann HA. Discontinuation of growth hormone (GH) treatment during the transition phase is an important factor determining the phenotype of young adults with nonidiopathic childhood-onset GH deficiency. J Clin Endocrinol Metab 2010; 95:2646-54. [PMID: 20335451 DOI: 10.1210/jc.2009-2013] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Little is known about the impact of childhood-onset GH deficiency (GHD), in particular the duration of GH cessation during the transition phase, on adult phenotype. OBJECTIVE We investigated the association between the manifestations and management of GHD during childhood/adolescence and the clinical features of GHD in adulthood. DESIGN/SETTING/PATIENTS/INTERVENTION: Patients with reconfirmed childhood-onset GHD who resumed GH treatment as adults were identified from two sequential databases (n = 313). The cohort was followed up longitudinally from GH start in childhood to reinitiation of treatment in adulthood and 1 yr beyond. Analyses were performed in the total cohort and in subgroups of patients with idiopathic GHD (IGHD) and non-IGHD. The cohorts were stratified based on duration of GH cessation (short, < or = 2 yr; long, > 2 yr). MAIN OUTCOME MEASURES Regimen of pediatric GH administration, duration of GH interruption, IGF-I sd score, lipid concentrations, and quality of life were measured. RESULTS Mean duration of GH interruption was 4.4 yr. IGF-I sd score in adulthood was related to severity of childhood GHD. In non-IGHD patients, a longer duration of GH interruption was associated with a worse lipid profile (P < 0.0001). Non-IGHD patients who gained more height during childhood GH treatment reported better quality of life than those who gained less height (P < 0.05). CONCLUSIONS Pediatricians should tailor GH treatment, not only for its beneficial effect on growth but also for future health in adulthood. In adults with reconfirmed GHD, particularly those with non-IGHD, early recommencement of GH should be considered.
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Nyberg F. The role of the somatotrophic axis in neuroprotection and neuroregeneration of the addictive brain. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2010; 88:399-427. [PMID: 19897085 DOI: 10.1016/s0074-7742(09)88014-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Early studies have shown that the abuse of alcohol, central stimulants, and opiates such as heroin destroys brain cells, reducing attention span and memory. However, new research has suggested that there may be a way to regain some of the lost attention and recall. It has recently been shown that brain cells targeted for early death by continued opiate use can be salvaged by injections of synthetic human growth hormone (GH). GH is a polypeptide hormone, normally secreted by the anterior pituitary gland, which stimulates cell growth and controls body metabolism. Recombinant human GH is currently used in replacement therapy to alleviate the symptoms of adults and children with GH deficiency syndrome. The recent observation that GH can reverse morphine-induced cell damage could open the door to new ways of treating and preventing damage from the abuse of opiates in addicts and also of treating cell damage induced by alcohol and central stimulants. This article reviews current knowledge of the somatotrophic axis, including GH and insulin-like growth factor-1 (IGF-1), in the brain and also discusses the potential use of GH/IGF-1 as agents for treatment of brain pathology in addictive diseases.
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Affiliation(s)
- Fred Nyberg
- Department of Pharmaceutical Biosciences, Division of Biological Research on Drug Dependence, Uppsala University, S-75124 Uppsala, Sweden
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Nass R, Johannsson G, Christiansen JS, Kopchick JJ, Thorner MO. The aging population--is there a role for endocrine interventions? Growth Horm IGF Res 2009; 19:89-100. [PMID: 18977675 DOI: 10.1016/j.ghir.2008.09.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2008] [Revised: 09/04/2008] [Accepted: 09/15/2008] [Indexed: 12/25/2022]
Abstract
The expected increase in the aging population will have a significant impact on society and the health system in the coming years and decades. Enhancing healthspan, "healthy aging", and thus extending the time that the elderly are able to function independently is a significant task and is imperative. Age-dependent changes such as weight loss, sarcopenia and anorexia, which contribute to the development of frailty in the elderly are discussed. The role of the age-dependent decrease in growth hormone secretion in this process and the potential benefits and risks of hormonal interventions to delay, prevent or reverse frailty in the elderly are reviewed.
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Affiliation(s)
- Ralf Nass
- Division of Endocrinology and Metabolism, University of Virginia, P.O. Box 801411, Charlottesville, VA 22908, USA.
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17
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Mathioudakis N, Salvatori R. Adult-onset growth hormone deficiency: causes, complications and treatment options. Curr Opin Endocrinol Diabetes Obes 2008; 15:352-8. [PMID: 18594276 DOI: 10.1097/med.0b013e3282ffd97d] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Description of the progresses related to the complications and treatment of adult-onset growth hormone deficiency. RECENT FINDINGS Growth hormone deficiency in adults has gained attention as a clinical syndrome associated with increased morbidity and possibly mortality. Many studies have been conducted on the consequences of growth hormone deficiency and of its replacement, supporting its use in appropriate patients. Early studies were characterized by a high incidence of side effects due to a lack of pilot data to guide appropriate dosing. Given the wide variability in individual responsiveness to growth hormone therapy based on age, sex, and body composition, recent work has been dedicated to understanding which patients derive benefit from therapy, minimizing side effects, and ensuring cost-effectiveness. SUMMARY Long-term prospective trials have shown that growth hormone replacement therapy results in improvements in body composition, dyslipidemia, bone mineral density, and quality of life. The effects on endpoints such as cardiovascular morbidity and mortality and fractures are, however, not fully proven. Randomized trials that compare homogenous groups of growth hormone deficiency patients are still needed. Given the high cost of treatment, dynamic testing for growth hormone deficiency should only be performed in patients in whom there is high clinical suspicion, and therapy should be limited to those with biochemically proven growth hormone deficiency.
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Affiliation(s)
- Nestoras Mathioudakis
- Division of Endocrinology and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287. USA
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18
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Malberg JE, Platt B, Rizzo SJS, Ring RH, Lucki I, Schechter LE, Rosenzweig-Lipson S. Increasing the levels of insulin-like growth factor-I by an IGF binding protein inhibitor produces anxiolytic and antidepressant-like effects. Neuropsychopharmacology 2007; 32:2360-8. [PMID: 17342171 DOI: 10.1038/sj.npp.1301358] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The present studies were conducted to determine if increasing central levels of the neurotrophic factor insulin-like growth factor-1 (IGF-I) either directly or indirectly produces anxiolytic and antidepressant-like effects in the mouse. Central levels of IGF-I can be increased directly, by administering IGF-I, or indirectly by blocking the insulin-like growth factor binding proteins (IGFBPs). The IGFBP family has the unique ability to regulate IGF-I levels by sequestering IGF-I into an inactive complex. Therefore, an IGFBP inhibitor increases the level of IGF-I available to bind to its receptor. Intracerebroventricular (icv) administration of the nonspecific IGFBP inhibitor NBI-31772 (10-30 microg) increases the number of punished crossings in the four-plate test and NBI-31772 (0.3-10 microg) increases time spent in the open quadrant of the elevated zero maze (EZM), indicative of anxiolytic-like effects. NBI-31772 (3-30 microg) also decreases immobility time in the tail suspension test, indicative of antidepressant-like effects. Similarly, icv administration of IGF-I (0.1 microg) produces anxiolytic-like effects in the four-plate test and IGF-1 (0.3-1 microg) produces anxiolytic-like effects in the EZM. IGF-I (10 microg) also produces antidepressant-like effects in the tail suspension test. Coadministration of the IGF-I receptor antagonist JB1 with NBI-31772 or IGF-I blocks the anxiolytic-like and antidepressant-like effects of these compounds. These results suggest that NBI-31772 produces behavioral effects by increasing levels of IGF-I that in turn activate the IGF-I receptor. The present studies demonstrate that an IGFBP inhibitor mimics the behavioral effects of IGF-I and that IGFBP inhibition may represent a novel mechanism by which to increase IGF-I to treat depression and anxiety.
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Lue BH, Huang TS, Chen HJ. Physical distress, emotional status, and quality of life in patients with nasopharyngeal cancer complicated by post-radiotherapy endocrinopathy. Int J Radiat Oncol Biol Phys 2007; 70:28-34. [PMID: 17765405 DOI: 10.1016/j.ijrobp.2007.06.053] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2006] [Revised: 06/07/2007] [Accepted: 06/07/2007] [Indexed: 11/25/2022]
Abstract
PURPOSE To explore factors affecting quality of life (QOL) among patients with nasopharyngeal cancer (NPC) complicated by post-radiotherapy endocrinopathy. METHODS AND MATERIALS This cross-sectional study was conducted in a tertiary medical center and involved a total of 43 post-radiotherapy, recurrence-free NPC patients with endocrinopathy. They performed self-assessment of their emotional status using the Beck Anxiety Inventory and Beck Depression Inventory-II, and their QoL with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) questionnaire and the H&N35 cancer module. RESULTS Emotional and cognitive functioning of EORTC QLQ-C30 were the most affected. Fatigue, insomnia, and pain were the main concerns. Of the patients, 22 (51.2%) had anxiety and 19 (44.2%) had depression. Both depression and anxiety were negatively correlated with functional scales and global QoL but positively correlated with symptom scales. Multiple linear regression analysis revealed that physical distress symptoms of QLQ-C30 and physical functioning were the significant predictors of global QoL. Emotional and social functioning could predict depression, whereas emotional and physical functioning were significant predictors of anxiety. CONCLUSIONS NPC patients with post-radiotherapy endocrinopathy exhibit impaired cognitive function and negative emotions. Symptoms of physical distress play an important role in QoL perception. Measurement of EORTC QLQ-C30 can be a useful instrument for the early detection of patients' impaired cognitive function and psychological morbidity. The high psychological distress related to the endocrine disturbances or the impact of NPC itself needs further study.
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Affiliation(s)
- Bee-Horng Lue
- Department of Family Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
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20
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Kreitschmann-Andermahr I, Poll E, Hutter BO, Reineke A, Kristes S, Gilsbach JM, Saller B. Quality of life and psychiatric sequelae following aneurysmal subarachnoid haemorrhage: does neuroendocrine dysfunction play a role? Clin Endocrinol (Oxf) 2007; 66:833-7. [PMID: 17408419 DOI: 10.1111/j.1365-2265.2007.02821.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Patients who have sustained aneurysmal subarachnoid haemorrhage (SAH) often suffer persistent impairments in their quality of life (QoL) and psychological disturbances despite a good neurological outcome. In the light of the high prevalence of partial hypopituitarism in SAH survivors demonstrated in recent investigations, we aimed to determine whether neuroendocrine dysfunction has an impact on QoL and neurobehavioural symptoms in these patients. DESIGN/PATIENTS QoL, depression and psychological distress were assessed in 40 SAH survivors who had undergone endocrine function testing at least 1 year after the haemorrhage. MEASUREMENTS QoL was assessed using the Nottingham Health Profile (NHP), the Quality of Life Assessment of Growth Hormone Deficiency in Adults (QoL-AGHDA) and the Short Form-36 questionnaire (SF-36). The Beck Depression Inventory (BDI) and the Impact of Event Scale (IES) were used to evaluate depression and symptoms of current subjective distress in response to the SAH as a stressful life event, respectively. RESULTS In a stepwise multiple regression analysis, basal cortisol level was included as the first and often only predictor for several QoL domains assessing psychological aspects of well-being and depression whereas physical aspects of QoL were predicted primarily by neurological recovery from the SAH. Severe GH deficiency (GHD) was the first predictor for the criterion NHP subscale 'Energy' and highest stimulated ACTH level in the insulin tolerance test (ITT) was the first predictor for disturbed sleep as assessed with the NHP subscale 'Sleep'. CONCLUSION Our results provide preliminary data that neuroendocrine disturbances contribute to disturbed QoL, depression and sleeping disturbances in SAH patients.
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Abstract
The imminent rapid increase in numbers of aging adults will significantly impact society and the health system in the coming years. The imperative is to allow older adults to maintain their independence and health for as long as possible and to prevent the ravages of chronic diseases and disabilities or the development of frailty. Significant hormonal changes are observed with aging (eg, decline in growth hormone [GH]), and strikingly similar changes in body composition are seen in GH-deficient adults and during aging. This article reviews some of the studies describing the effects of GH and GH secretagogues on body composition and functionality in the elderly. In addition, safety concerns and the need for further controlled studies of these therapies in the elderly are discussed.
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Affiliation(s)
- Ralf Nass
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia, 450 Ray C. Hunt Drive, Charlottesville, VA 22903, USA
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22
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Abstract
Quality of life (QoL) has emerged as an end point in the evaluation of adults with growth hormone deficiency and acromegaly. QoL is measured with questionnaires designed to be used in general population or any kind of disease (generic) or aimed at the specific dimensions affected in a determined condition; these latter ones are more likely to identify the impairments caused by the underlying disease and the benefits of treatment. QoL, which is severely impaired in adults with growth hormone deficiency, improves and normalizes after growth hormone replacement therapy and this effect is maintained over several years. Acromegalic patients also exhibit severe impairment of QoL, which despite improvement after successful therapy still remains below the reference values of normal population. QoL in these chronic endocrine diseases can be used as an measure for clinical and therapeutic evaluation.
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Affiliation(s)
- Susan M Webb
- Department of Endocrinology, Hospital de Sant Pau, Autonomous University of Barcelona, Pare Claret 167, 08025 Barcelona, Spain.
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23
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Bradley C. Feedback on the FDA's February 2006 draft guidance on Patient Reported Outcome (PRO) measures from a developer of PRO measures. Health Qual Life Outcomes 2006; 4:78. [PMID: 17029628 PMCID: PMC1634851 DOI: 10.1186/1477-7525-4-78] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2006] [Accepted: 10/09/2006] [Indexed: 12/03/2022] Open
Abstract
I believe that the FDA guidelines have already had an impact in encouraging good practice in the use of PROs. There are, however, important improvements that need to be made to the guidelines, particularly in the use of health status and quality of life terminology. It is essential to distinguish between health status and quality of life and to use both terms. Nothing is to be gained and a great deal will be lost if the term quality of life (which has been misused as an umbrella term in the past) is abandoned and replaced with the term health status. Patients want us to consider their quality of life as well as their health. To abandon the term would be to forget about their quality of life and focus only on their health. Patients are well able to tell us what quality of life means to them and to rate the impact of a condition on their quality of life if we use individualised quality of life measures and individualised condition-specific quality of life measures to allow them to do so. Although my experience with PRO measures would support many of the recommendations in the guidelines there are others that I would not fully agree with or would contradict on the basis of my own research evidence. I have provided references to that research and hope that the FDA will feel able to do the same when they finalize their guidelines.
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Affiliation(s)
- Clare Bradley
- Health Psychology Research, Royal Holloway, University of London, Egham, Surrey TW20 0EX, UK.
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McMillan CV, Bradley C, Gibney J, Russell-Jones DL, Sönksen PH. Preliminary development of the new individualized HDQoL questionnaire measuring quality of life in adult hypopituitarism. J Eval Clin Pract 2006; 12:501-14. [PMID: 16987112 DOI: 10.1111/j.1365-2753.2006.00659.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The objectives were (1) to report the preliminary development of the Hormone Deficiency-dependent Quality of Life (HDQoL) questionnaire, a new individualized questionnaire in which respondents rate personally applicable domains for importance and impact of hormonal deficiency and its treatment; (2) to evaluate the HDQoL's psychometric properties for adults with hypopituitarism including growth hormone deficiency (GHD). METHODS Internal consistency reliability, aspects of validity, and sensitivity to change of the HDQoL were investigated in: (1) a cross-sectional survey of 157 adults with treated or untreated GHD; (2) a randomized, placebo-controlled study of 3 months' growth hormone (GH) withdrawal from 12 of 21 GH-treated adults. RESULTS Thirteen of the original 18 HDQoL domains were relevant and important for GH-deficient adults. The shorter 13-item HDQoL had excellent internal reliability (Cronbach's alpha coefficient = 0.914, n = 109), and was sensitive to sex differences (cross-sectional study): women perceived worse present QoL than men [t(149.8) = 2.33, P = 0.021]. The HDQoL was sensitive to change (GH-withdrawal study) with a significant between-group difference in change in domain scores for things I can do physically[t(16) = 2.47, P = 0.025, 2-tailed], patients withdrawn from GH reporting greater negative impact of hormone deficiency on this domain at end-point. Qualitative work resulted in the addition of seven new HDQoL domains, including energy and bodily pain. CONCLUSION The HDQoL, although at an early stage of development, proved useful in identifying expected changes following GH withdrawal. The extended 20-item version is recommended for further evaluation in assessing the impact of hypopituitarism on QoL.
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Affiliation(s)
- Carolyn V McMillan
- Department of Psychology, Royal Holloway, University of London, Egham, Surrey, UK.
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25
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Woodhouse LJ, Mukherjee A, Shalet SM, Ezzat S. The influence of growth hormone status on physical impairments, functional limitations, and health-related quality of life in adults. Endocr Rev 2006; 27:287-317. [PMID: 16543384 DOI: 10.1210/er.2004-0022] [Citation(s) in RCA: 133] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The availability of recombinant human GH and somatostatin analogs has resulted in widespread treatment for adults with GH deficiency (GHD) and those with GH excess (acromegaly). Despite being at opposite ends of the spectrum in terms of their GH/IGF-I axis, both of these populations experience overlapping somatic impairments. Adults with untreated GHD have low circulating levels of IGF-I that manifest as altered body composition with increased fat and reduced lean body and skeletal muscle mass. At the other end of the spectrum, adults with GH excess, who have elevated levels of IGF-I, also have altered body composition. Impairments that result from disorders of either GHD or GH excess are both associated with increased functional limitations, such as reduced ability to walk quickly for prolonged periods, and poorer health-related quality of life (HR-QoL). Adults with untreated GHD and GH excess both commonly complain of excessive fatigue that seems to be associated more with impaired aerobic than muscular performance. Several studies have documented that administration of GH or somatostatin analogs to adults with GHD or GH excess, respectively, ameliorates abnormal biochemical profile and the associated somatic impairments. However, whether these improvements translate into improved physical function in adults with GHD or GH excess remains largely unknown, and their impact on HR-QoL controversial. Review of placebo-controlled trials to date suggests that GH and somatostatin analogs have greater effects on gas exchange and aerobic performance than as anabolic agents on skeletal muscle mass and function. Future investigations should include dose-response studies to establish the optimal combination of pharmacological agents plus exercise required to improve not only biochemical markers but also physical function and HR-QoL in adults with GHD or GH excess.
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Affiliation(s)
- Linda J Woodhouse
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
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26
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Millan MJ. Multi-target strategies for the improved treatment of depressive states: Conceptual foundations and neuronal substrates, drug discovery and therapeutic application. Pharmacol Ther 2006; 110:135-370. [PMID: 16522330 DOI: 10.1016/j.pharmthera.2005.11.006] [Citation(s) in RCA: 388] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2005] [Accepted: 11/28/2005] [Indexed: 12/20/2022]
Abstract
Major depression is a debilitating and recurrent disorder with a substantial lifetime risk and a high social cost. Depressed patients generally display co-morbid symptoms, and depression frequently accompanies other serious disorders. Currently available drugs display limited efficacy and a pronounced delay to onset of action, and all provoke distressing side effects. Cloning of the human genome has fuelled expectations that symptomatic treatment may soon become more rapid and effective, and that depressive states may ultimately be "prevented" or "cured". In pursuing these objectives, in particular for genome-derived, non-monoaminergic targets, "specificity" of drug actions is often emphasized. That is, priority is afforded to agents that interact exclusively with a single site hypothesized as critically involved in the pathogenesis and/or control of depression. Certain highly selective drugs may prove effective, and they remain indispensable in the experimental (and clinical) evaluation of the significance of novel mechanisms. However, by analogy to other multifactorial disorders, "multi-target" agents may be better adapted to the improved treatment of depressive states. Support for this contention is garnered from a broad palette of observations, ranging from mechanisms of action of adjunctive drug combinations and electroconvulsive therapy to "network theory" analysis of the etiology and management of depressive states. The review also outlines opportunities to be exploited, and challenges to be addressed, in the discovery and characterization of drugs recognizing multiple targets. Finally, a diversity of multi-target strategies is proposed for the more efficacious and rapid control of core and co-morbid symptoms of depression, together with improved tolerance relative to currently available agents.
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Affiliation(s)
- Mark J Millan
- Institut de Recherches Servier, Centre de Recherches de Croissy, Psychopharmacology Department, 125, Chemin de Ronde, 78290-Croissy/Seine, France.
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McMillan CV, Bradley C, Gibney J, Russell-Jones DL, Sönksen PH. Psychometric properties of two measures of psychological well-being in adult growth hormone deficiency. Health Qual Life Outcomes 2006; 4:16. [PMID: 16553952 PMCID: PMC1475840 DOI: 10.1186/1477-7525-4-16] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2005] [Accepted: 03/22/2006] [Indexed: 12/02/2022] Open
Abstract
Background Psychometric properties of two measures of psychological well-being were evaluated for adults with growth hormone deficiency (GHD): the General Well-being Index, (GWBI) – British version of the Psychological General Well-being Index, and the 12-item Well-being Questionnaire (W-BQ12). Methods Reliability, structure and other aspects of validity were investigated in a cross-sectional study of 157 adults with treated or untreated GHD, and sensitivity to change in a randomised placebo-controlled study of three months' growth hormone (GH) withdrawal from 12 of 21 GH-treated adults. Results Very high completion rates were evidence that both questionnaires were acceptable to respondents. Factor analyses did not indicate the existence of useful GWBI subscales, but confirmed the validity of calculating a GWBI Total score. However, very high internal consistency reliability (Cronbach's alpha = 0.96, N = 152), probably indicated some item redundancy in the 22-item GWBI. On the other hand, factor analyses confirmed the validity of the three W-BQ12 subscales of Negative Well-being, Energy, and Positive Well-being, each having excellent internal reliability (alphas of 0.86, 0.86 and 0.88, respectively, N from 152 to 154). There was no sign of item redundancy in the highly acceptable Cronbach's alpha of 0.93 (N = 148) for the whole W-BQ12 scale. Whilst neither questionnaire found significant differences between GH-treated and non-GH-treated patients, there were correlations (for GH-treated patients) with duration of GH treatment for GWBI Total (r = -0.36, p = 0.001, N = 85), W-BQ12 Total (r = 0.35, p = 0.001, N = 88) and for all W-BQ12 subscales: thus the longer the duration of GH treatment (ranging from 0.5 to 10 years), the better the well-being. Both questionnaires found that men had significantly better overall well-being than women. The W-BQ12 was more sensitive to change than the GWBI in the GH-Withdrawal study. A significant between-group difference in change in W-BQ12 Energy scores was found [t(18) = 3.25, p = 0.004, 2-tailed]: patients withdrawn from GH had reduced energy at end-point. The GWBI found no significant change. Conclusion The W-BQ12 is recommended in preference to the GWBI to measure well-being in adult GHD: it is considerably shorter, has three useful subscales, and has greater sensitivity to change.
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Affiliation(s)
- Carolyn V McMillan
- Department of Psychology, Royal Holloway, University of London, Egham, Surrey, TW20 0EX, UK
| | - Clare Bradley
- Department of Psychology, Royal Holloway, University of London, Egham, Surrey, TW20 0EX, UK
| | - James Gibney
- Department of Endocrinology, Adelaide & Meath Hospitals, incorporating the National Children's Hospital, Tallaght, Dublin 24, Eire, UK
| | - David L Russell-Jones
- Department of Diabetes and Endocrinology, Royal Surrey County Hospital, Guildford, UK
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Deijen JB, Arwert LI, Witlox J, Drent ML. Differential effect sizes of growth hormone replacement on Quality of Life, well-being and health status in growth hormone deficient patients: a meta-analysis. Health Qual Life Outcomes 2005; 3:63. [PMID: 16236167 PMCID: PMC1277839 DOI: 10.1186/1477-7525-3-63] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2005] [Accepted: 10/19/2005] [Indexed: 12/02/2022] Open
Abstract
Background Patients with growth hormone deficiency (GHD) frequently report to suffer from an impaired Quality of Life (QoL) and growth hormone (GH) substitution is found to improve this. However, the same test may be used for measuring QoL, well-being or health status in different studies. QoL has been defined as the subjective appraisal of one's current life based primarily on psychological function. The most important in the appraisal of well-being is mental function and concerning health status patients evaluate physical function as most important. To differentiate the effects of GH replacement on psychological variables in patients with GHD we carried out a number of meta-analyses, classifying questionnaires into instruments measuring QoL, psychological well-being and health status. Methods We searched the electronic databases PUBMED and PiCarta from 1985 to 2004. Studies were included that evaluated the effect of GH on patient-reported outcomes in adults with GHD (aged 18 years and above). According to generally accepted definitions we classified the questionnaires as instruments measuring QoL, well-being and health status. By means of meta-analyses the average effect size (d) for QoL, well-being and health status was calculated. Results and Discussion Based on open studies GH replacement is found to improve QoL with a small effect size (d = 0.18), well-being with a medium effect size (d = 0.47) and health status with a small effect size (d = 0.26). As the effect size of well-being is most pronounced the generally reported effects of GH replacement on QoL may be overestimated and actually reflect the effect on well-being. Conclusion To get more insight in the specific psychological effects of GH treatment it is recommended that instruments selected for these studies should be more consistently classified as instruments measuring QoL, well-being or health status.
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Affiliation(s)
- Jan Berend Deijen
- Department of Clinical Neuropsychology, Free University, van der Boechorststraat 1, 1081 BT Amsterdam, the Netherlands
| | - Lucia I Arwert
- Department of Endocrinology, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, the Netherlands
| | - Joost Witlox
- Department of Clinical Neuropsychology, Free University, van der Boechorststraat 1, 1081 BT Amsterdam, the Netherlands
| | - Madeleine L Drent
- Department of Endocrinology, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, the Netherlands
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Persson AI, Thorlin T, Eriksson PS. Comparison of immunoblotted delta opioid receptor proteins expressed in the adult rat brain and their regulation by growth hormone. Neurosci Res 2005; 52:1-9. [PMID: 15811547 DOI: 10.1016/j.neures.2005.01.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2004] [Revised: 01/07/2005] [Accepted: 01/11/2005] [Indexed: 11/30/2022]
Abstract
It has previously been suggested that exogenous growth hormone (GH) affect quality of life and higher brain functions through the endogenous opioid system. Recently, we showed that GH down-regulate 72 and 48 kDa delta opioid receptor (DOR) proteins in the adult rat cerebral cortex and cerebellum. In the present study, we found that an antiserum raised against the N-terminus of the DOR also recognizes a 36 kDa protein, not recognized by a C-terminus-directed antiserum. We aimed to investigate the identity of the 72, 48 and 36 kDa proteins and to further study the effects of GH on their expression in different brain regions. The expression was studied in hypophysectomized (Hx) and untreated normal female rats. One subgroup of Hx rats received GH as a daily subcutaneous injection for 19 days. Our data show that treatment with GH in Hx rats normalized the expression of the 72 kDa protein in the cerebral cortex, whereas no significant effect were observed for the 48 or 36 kDa proteins. However, GH significantly reduced the ratio between the 72 and 36 kDa proteins in different brain regions of Hx rats. Our data suggest that GH reduces the levels of a 72 kDa DOR that likely represents a dimeric form of a 36 kDa DOR post-translationally truncated at the C-terminus, and that altered receptor dimerization may be involved in GH induced effects in the central nervous system.
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Affiliation(s)
- Anders I Persson
- The Institute of Clinical Neuroscience, Göteborg University, S-413 45 Göteborg, Sweden.
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Biermasz NR, van Thiel SW, Pereira AM, Hoftijzer HC, van Hemert AM, Smit JWA, Romijn JA, Roelfsema F. Decreased quality of life in patients with acromegaly despite long-term cure of growth hormone excess. J Clin Endocrinol Metab 2004; 89:5369-76. [PMID: 15531483 DOI: 10.1210/jc.2004-0669] [Citation(s) in RCA: 154] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The long-term impact of acromegaly on subjective well-being after treatment of GH excess is unclear. Therefore, we evaluated quality of life by validated questionnaires in a cross-sectional study of 118 successfully treated acromegalic patients. The initial treatment was transsphenoidal surgery in most patients (92%), if necessary followed by radiotherapy or octreotide. All patients were in remission at the time of assessment (GH, <1.9 mug/liter; normal IGF-I for age). General perceived well-being was reduced compared with controls for all subscales (P < 0.001) as measured by the Nottingham Health Profile and the Short Form-36. Acromegalic patients also had lower scores on fatigue (Multidimensional Fatigue Index) and anxiety and depression (Hospital Anxiety and Depression Scale). Radiotherapy was associated with decreased quality of life in all subscales except for the Hospital Anxiety and Depression Scale, and worsened quality of life significantly, according to the fatigue scores. Somatostatin analog treatment was not associated with improved quality of life. Independent predictors of quality of life were age (physical subscales and Nottingham Health Profile), disease duration (social isolation and personal relations), and radiotherapy (physical and fatigue subscales). In conclusion, patients cured after treatment for acromegaly have a persistently decreased quality of life despite long-term biochemical cure of GH excess. Radiotherapy especially is associated with a reduced quality of life.
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Affiliation(s)
- Nienke R Biermasz
- Department of Endocrinology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
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Abstract
There are two principal directions in ageing research: (i) the quest for understanding the mechanisms that determine the length of life and the use of such knowledge in order to find a potentially life extending treatment and (ii) the attempt to improve the quality of life in the elderly by reversing or preventing functional decline of different tissues without primarily extending life span. This chapter addresses the importance of assessing the potential impact of interventions on quality of life rather than extending life.
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Affiliation(s)
- R Nass
- Department of Medicine, University of Virginia Health System, Box 800466, Charlottesville, VA 22908, USA
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Woodcock A, Bradley C, Plowright R, ffytche T, Kennedy-Martin T, Hirsch A. The influence of diabetic retinopathy on quality of life: interviews to guide the design of a condition-specific, individualised questionnaire: the RetDQoL. PATIENT EDUCATION AND COUNSELING 2004; 53:365-383. [PMID: 15186876 DOI: 10.1016/j.pec.2003.10.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2003] [Revised: 10/12/2003] [Accepted: 10/26/2003] [Indexed: 05/24/2023]
Abstract
An individualised measure of the impact of diabetic retinopathy on quality of life (QoL) was developed, using a four-phase iterative approach, incorporating qualitative and quantitative methods. In semi-structured interviews, eleven people with diabetic retinopathy in each of two UK and two German hospitals described how QoL would be different without diabetic retinopathy. They completed and commented on the latest Retinopathy Dependent QoL (RetDQoL) draft. Interviews were content analysed before questionnaire revision and translation for the next centre. Twenty-six men and 18 women were interviewed: median age 60.5 (28-82) years; severity ranged from untreated background diabetic retinopathy to proliferative diabetic retinopathy requiring photocoagulation in both eyes, and vitrectomy. The resulting 26-domain RetDQoL asks about the impact of 'diabetic eye problems'. Iterative methodology ensured good understanding, face and content validity. It can be self- or interviewer-completed. Visual impairment, worries and movement restrictions impaired many aspects of QoL, with impacts before vision loss. Practice implications relate to using the RetDQoL and improving practitioner-patient communication.
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Affiliation(s)
- Alison Woodcock
- Department of Psychology, Royal Holloway, University of London, Egham, Surrey TW20 0EX, UK.
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McMillan CV, Bradley C, Giannoulis M, Martin F, Sönksen PH. Preliminary development of a new individualised questionnaire measuring quality of life in older men with age-related hormonal decline: the A-RHDQoL. Health Qual Life Outcomes 2003; 1:51. [PMID: 14613571 PMCID: PMC269991 DOI: 10.1186/1477-7525-1-51] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2003] [Accepted: 10/06/2003] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is increasing interest in hormone replacement therapy to improve health and quality of life (QoL) of older men with age-related decline in hormone levels. This paper reports the preliminary development and evaluation of the psychometric properties of a new individualised questionnaire, the A-RHDQoL, measuring perceived impact of age-related hormonal decline on QoL of older men. A-RHDQoL design was based on the HDQoL for people with growth hormone (GH) deficiency and the ADDQoL (for diabetes). METHODS Internal consistency reliability and some aspects of validity of the A-RHDQoL were investigated in a cross-sectional survey of 128 older men (age range: 64 - 80 yrs), being screened for inclusion in a trial of GH and testosterone (T) replacement, and who completed the A-RHDQoL once. Respondents rated personally applicable life domains for importance and impact of their hormonal decline. A single overview item measured present QoL. Serum levels of Insulin-like Growth Factor-I and total T were measured. RESULTS Of the 24 A-RHDQoL domains, 21 were rated as relevant and important for older men. All domains were perceived as negatively impacted by hormonal decline. The most negatively impacted domains were: memory (-4.54 +/- 3.02), energy (-4.44 +/- 2.49), sex life (-4.34 +/- 3.08) and physical stamina (-4.29 +/- 2.41), (maximum range -9 to +9). The shorter 21-domain A-RHDQoL had high internal consistency reliability (Cronbach's alpha coefficient = 0.935, N = 103) and applicable domains could be weighted and summed into an overall Average Weighted Impact score. The questionnaire was acceptable to the majority of respondents and content validity was good. The single overview item measuring present QoL correlated significantly with total T levels [r = 0.26, p <0.01, N = 114]. CONCLUSION The new 21-item A-RHDQoL is an individualised questionnaire measuring perceived impact of age-related hormonal decline on the QoL of older men. The internal consistency reliability and content validity of the A-RHDQoL are established, but the measure is at an early stage of its development and its sensitivity to change and other psychometric properties need now to be evaluated in clinical trials of hormone replacement in older men.
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Affiliation(s)
- Carolyn V McMillan
- Department of Psychology, Royal Holloway, University of London, Egham, Surrey, UK
| | - Clare Bradley
- Department of Psychology, Royal Holloway, University of London, Egham, Surrey, UK
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