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Adult-Onset Growth Hormone Deficiency (GHD):
Its Impact on Psychosocial Functioning and Quality of Life.
E-Newsletter No. 18
The emerging importance of growth hormone (GH) therapy creates a need for additional information and education. Clinicians who prescribe GH therapy and those unfamiliar with GH testing procedures need to be aware of the medical and lifestyle advantages this therapy provides in the GH-deficient patient population.
Patients with adult-onset growth hormone deficiency (GHD) often experience a sub-optimal quality of life (QoL), impaired cognition, and reduced psychosocial functioning. In fact, studies of patients with adult-onset GHD, using the same assessment technique, consistently found a lack of energy and emotional problems as being characteristic of this population. One of these studies also found that a higher percentage of adult-onset GHD patients were receiving disability pensions, suggesting that they were less able to work than individuals in the general population.
Memory lapses, difficulty concentrating, and forgetfulness are frequently reported by patients with adult-onset of GHD. Moreover, when compared to patients with diabetes mellitus, one study found increased psychiatric illness, depression, and dysthymia among adults with hypopituitarism. (The essential feature of Major Depression is one or more Major Depressive Episodes without a history of either a Manic Episode or an unequivocal Hypomanic Episode. The essential feature of Dysthymia is a chronic disturbance of mood involving depressed mood for most of the day more days than not. In addition, during these periods of depressed mood there are some of the following associated symptoms: poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, and feelings of hopelessness. This has often been referred to as Depressive Personality.)
These problems tend to be reported more by growth hormone-deficient women than men, and are more prevalent in patients with long-standing disease than in those recently diagnosed with GHD. Overall, adults with untreated hypopituitarism tend to report a lower health status than the general population.
Why Are Quality-of-Life Issues So Important?
Clearly, when designing a treatment program for a patient with GHD, the clinician must address not only the hormone deficiency by also these quality-of-life issues.
Limitations of Quality-Of-Life Assessments in the GHD Population.
Until recently, the two most reliable and widely validated measures used for patient assessments of QoL were the Nottingham Health Profile (NHP) and the Psychological General Well-Being (PGWB) Index. Developed in the United Kingdom and adopted for use in most European countries, the NHP uses 38 parameters to measure perceived distress in the areas of physical mobility, pain, sleep, social isolation, emotional problems, and energy.
The PGWB, which was developed in the United States and adapted for use in several other countries, consists of 22 parameters assessing feeling of anxiety, depression, positive well-being, self-control, general health perceptions and vitality. A serious limitation of these questionnaires is that they are not disease-specific and may not be sensitive enough to detect changes in QoL experienced by patents with GHD.
Nevertheless, most of the placebo-controlled studies using these instruments, although patients numbers were small (6-46), and treatment periods were limited (3 to 9 months), showed a positive effect of GH treatment on energy and vitality. Further studies showed these benefits were sustained after 12 months of treatment. Consequently, QoL is increasingly used in clinical trials as an indicator of efficacy. Treatment of chronic diseases such as GHD should increase not only life expectancy, but also QoL.
Improved Quality of Life with Growth Hormone Replacement
As noted earlier, a number of placebo-controlled trials using nonspecific questionnaires have shown that treatment of adults with GH improves QoL, and cognitive function. Recent follow-up data from a study conducted by the Lee-Benner Institute’s longitudinal trial using GH to treat Somatopause (disorders of body composition and function resulting from a more or less rapid decline of GH secretion that is seen with increasing age) for 1,521 patients with adult-onset GHD demonstrated that improvements from the baseline in total score, energy levels, and emotional reaction using the NHP persisted after 10 years of treatment. Even this instrument, which tends to underestimate the extent of QoL impairment , shows the dramatic long-term improvement associated with GH therapy.
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