Download PDF
CC BY-NC-ND 4.0 · Avicenna J Med 2020; 10(04): 215-222
DOI: 10.4103/ajm.ajm_46_20
Original Article

Physician’ attitudes to growth hormone replacement therapy in adults following pituitary surgery: Results of an online survey

Aishah Ekhzaimy
Department of Medicine, Endocrinology Division, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
,
Salem A Beshyah
Department of Endocrinology, Mediclinic Airport Road Hospital, Abu Dhabi, United Arab Emirates
Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates
,
Khaled M Al-Dahmani
Department of Medicine, United Arab Emirates University, United Arab Emirates
Division of Endocrinology, Tawam Hospital, Al Ain, United Arab Emirates
,
Mussa H AlMalki
Obesity, Endocrine and Metabolism Centre, King Fahad Medical City, Riyadh, Saudi Arabia
College of Medicine, King Fahad Medical City, King Saud bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
› Author Affiliations
Subject Editor: Financial support and sponsorship Nil.
› Further Information
Also available at
   Permissions and Reprints

Abstract

Objective: The aim of this study was to evaluate physician attitudes and practices in the management of adult growth hormone deficiency (GHD) following pituitary surgery. Materials and Methods: An online questionnaire survey was sent to a sample group of physicians. Results: A total of 131 respondents provided usable responses. More than three quarters were senior physicians, with most practicing in tertiary care centers (73%). Four-fifths of the respondents see at least 1 to 5 patients with GHD following pituitary surgery per year. Seventy-four percent acknowledge the benefit in principle of growth hormone replacement therapy (GHRT) for patients with GHD after pituitary surgery. Most respondents (84%) would only consider GHRT for symptomatic patients. However, 16% stated that patients with GHD after pituitary surgery generally suffer from the side effects of GHRT. Forty-four percent said that the serum insulin-like growth factor-1 (IGF-1) level is the best screening test for assessing GHD after pituitary surgery but 57% of the respondents would use IGF-I levels, and 29% the insulin tolerance test (ITT), in patients with a documented deficiency in three pituitary axes. The main barriers to long-term GHRT use were that it requires injections (67%), and is costly with limited supply (61%). Other reasons not to use GHRT include an absence of GHD symptoms and apparent GHT ineffectiveness (44%), physician lack of familiarity with the medication (40%), and lack of adherence to available guidelines (38%). Conclusion: This survey addressed physician attitudes and practices in recognizing and treating GHD in adult’s post-pituitary surgery. Regional guidelines must be developed to help address/tackle these issues and assist physicians in understanding and treating this condition.

Keywords

Adult growth hormone deficiency - growth hormone - insulin-like growth factor-1


Publication History

Article published online:
04 August 2021

© 2020. Syrian American Medical Society. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 

  • References

  • 1 Cuneo RC, Salomon F, McGauley GA, Sönksen PH. The growth hormone deficiency syndrome in adults. Clin Endocrinol (Oxf) 1992; 37: 387-97
    CrossrefPubMedGoogle Scholar
  • 2 Rosén T, Bengtsson BÅ. Premature mortality due to cardiovascular disease in hypopituitarism. Lancet 1990; 336: 285-8
    CrossrefPubMedGoogle Scholar
  • 3 Beshyah SA, Johnston DG. Cardiovascular disease and risk factors in adults with hypopituitarism. Clin Endocrinol (Oxf) 1999; 50: 1-15
    CrossrefPubMedGoogle Scholar
  • 4 Bates AS. The effect of hypopituitarism on life expectancy. J Clin Endocrinol Metab 1996; 81: 1169-72
    PubMedGoogle Scholar
  • 5 Uzunova I, Kirilov G, Zacharieva S, Shinkov A, Borissova AM, Kalinov K. Individual risk factors of the metabolic syndrome in adult patients with growth hormone deficiency – A cross-sectional case-control study. Exp Clin Endocrinol Diabetes 2014; 123: 39-43
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Ahmad AM, Hopkins MT, Thomas J, Ibrahim H, Fraser WD, Vora JP. Body composition and quality of life in adults with growth hormone deficiency; effects of low-dose growth hormone replacement. Clin Endocrinol (Oxf) 2001; 54: 709-17
    CrossrefPubMedGoogle Scholar
  • 7 Molitch ME, Clemmons DR, Malozowski S, Merriam GR, Vance ML. Endocrine Society. Evaluation and treatment of adult growth hormone deficiency: An endocrine society clinical practice guideline. J Clin Endocrinol Metab 2011; 96: 1587-609
    CrossrefPubMedGoogle Scholar
  • 8 Schneider HJ, Aimaretti G, Kreitschmann-Andermahr I, Stalla GK, Ghigo E. Hypopituitarism. Lancet 2007; 369: 1461-70
    CrossrefPubMedGoogle Scholar
  • 9 Jørgensen JOL, Thuesen L, Ingemann-Hansen T, Pedersen SA, Jørgensen I, Skakkebaek NE. et al. Beneficial effects of growth hormone treatment in GH-deficient adults. The Lancet 1989; 333: 1221-5
    CrossrefPubMedGoogle Scholar
  • 10 de Boer H, Blok GJ, Van der Veen EA. Clinical aspects of growth hormone deficiency in adults. Endocr Rev 1995; 16: 63-86
    CrossrefPubMedGoogle Scholar
  • 11 Carroll PV, Christ ER, Bengtsson BÅ, Carlsson L, Christiansen JS, Clemmons D. et al. Growth hormone deficiency in adulthood and the effects of growth hormone replacement: A review. J Clin Endocrinol Metabol 1998; 83: 382-95
    CrossrefPubMedGoogle Scholar
  • 12 Russell-Jones DL, Watts GF, Weissberger A, Naoumova R, Myers J, Thompson GR. et al. The effect of growth hormone replacement on serum lipids, lipoproteins, apolipoproteins and cholesterol precursors in adult growth hormone deficient patients. Clin Endocrinol (Oxf) 1994; 41: 345-50
    CrossrefPubMedGoogle Scholar
  • 13 Carroll PV, Littlewood R, Weissberger AJ, Bogalho P, McGauley G, Sönksen PH. et al. The effects of two doses of replacement growth hormone on the biochemical, body composition and psychological profiles of growth hormone-deficient adults. Eur J Endocrinol 1997; 137: 146-53
    CrossrefPubMedGoogle Scholar
  • 14 Hoffman AR, Kuntze JE, Baptista J, Baum HB, Baumann GP, Biller BM. et al. Growth hormone (GH) replacement therapy in adult-onset gh deficiency: Effects on body composition in men and women in a double-blind, randomized, placebo-controlled trial. J Clin Endocrinol Metab 2004; 89: 2048-56
    CrossrefPubMedGoogle Scholar
  • 15 Hatrick AG, Boghalo P, Bingham JB, Ayres AB, Sonksen PH, Russell-Jones DL. Does GH replacement therapy in adult GH-deficient patients result in recurrence or increase in size of pituitary tumours?. Eur J Endocrinol 2002; 146: 807-11
    CrossrefPubMedGoogle Scholar
  • 16 Arnold JR, Arnold DF, Marland A, Karavitaki N, Wass JA. GH replacement in patients with non-functioning pituitary adenoma (NFA) treated solely by surgery is not associated with increased risk of tumour recurrence. Clin Endocrinol (Oxf) 2009; 70: 435-8
    CrossrefPubMedGoogle Scholar
  • 17 Frajese G. Hypothalamo-pituitary surveillance imaging in hypopituitary patients receiving long-term GH replacement therapy. J Clin Endocrinol Metab 2001; 86: 5172-5
    CrossrefPubMedGoogle Scholar
  • 18 Yang HB, Zhang MQ, Pan H, Zhu HJ. Management of adult growth hormone deficiency at peking union medical college hospital: A survey among physicians. Chin Med Sci J 2016; 31: 168-72
    CrossrefPubMedGoogle Scholar
  • 19 Kargi AY, Merriam GR. Diagnosis and treatment of growth hormone deficiency in adults. Nat Rev Endocrinol 2013; 9: 335-45
    CrossrefPubMedGoogle Scholar
  • 20 Abdi L, Sahnoun-Fathallah M, Morange I, Albarel F, Castinetti F, Giorgi R. et al. A monocentric experience of growth hormone replacement therapy in adult patients. Ann Endocrinol (Paris) 2014; 75: 176-83
    CrossrefPubMedGoogle Scholar
  • 21 Mathioudakis N, Salvatori R. Adult-onset growth hormone deficiency: Causes, complications and treatment options. Curr Opin Endocrinol Diabetes Obes 2008; 15: 352-8
    CrossrefPubMedGoogle Scholar
  • 22 Al-Shoumer KA, Gray R, Anyaoku V, Hughes C, Beshyah S, Richmond W. et al. Effects of four years’ treatment with biosynthetic human growth hormone (GH) on glucose homeostasis, insulin secretion and lipid metabolism in GH-deficient adults. Clin Endocrinol (Oxf) 1998; 48: 795-802
    CrossrefPubMedGoogle Scholar
  • 23 Reed ML, Merriam GR, Kargi AY. Adult growth hormone deficiency - benefits, side effects, and risks of growth hormone replacement. Front Endocrinol (Lausanne) 2013; 4: 64
    PubMedGoogle Scholar
  • 24 Cook DM, Yuen KC, Biller BM, Kemp SF, Vance ML. American Association of Clinical Endocrinologists. American association of clinical endocrinologists medical guidelines for clinical practice for growth hormone use in growth hormone-deficient adults and transition patients – 2009 update. Endocr Pract 2009; 15: 1-29
    CrossrefPubMedGoogle Scholar
  • 25 Yuen KC, Tritos NA, Samson SL, Hoffman AR, Katznelson L. American association of clinical endocrinologists and American college of endocrinology disease state clinical review: Update on growth hormone stimulation testing and proposed revised cut-point for the glucagon stimulation test in the diagnosis of adult growth hormone deficiency. Endocr Pract 2016; 22: 1235-44
    CrossrefPubMedGoogle Scholar
  • 26 Pfeifer M, Verhovec R, Zizek B, Prezelj J, Poredos P, Clayton RN. Growth hormone (GH) treatment reverses early atherosclerotic changes in GH-deficient adults. J Clin Endocrinol Metab 1999; 84: 453-7
    PubMedGoogle Scholar
  • 27 Erfurth EM, Bülow B, Eskilsson J, Hagmar L. High incidence of cardiovascular disease and increased prevalence of cardiovascular risk factors in women with hypopituitarism not receiving growth hormone treatment: Preliminary results. Growth Horm IGF Res 1999; 9: 21-4
    CrossrefPubMedGoogle Scholar
  • 28 Molitch ME, Clemmons DR, Malozowski S, Merriam GR, Shalet SM, Vance ML. et al Endocrine Society’s Clinical Guidelines Subcommittee. Evaluation and treatment of adult growth hormone deficiency: An endocrine society clinical practice guideline. J Clin Endocrinol Metab 2006; 91: 1621-34
    CrossrefPubMedGoogle Scholar
  • 29 Allen DB, Backeljauw P, Bidlingmaier M, Biller BM, Boguszewski M, Burman P. et al. GH safety workshop position paper: A critical appraisal of recombinant human GH therapy in children and adults. Eur J Endocrinol 2016; 174: P1-9
    CrossrefPubMedGoogle Scholar
  • 30 Maison P, Griffin S, Nicoue-Beglah M, Haddad N, Balkau B, Chanson P. Impact of Growth Hormone (GH) treatment on cardiovascular risk factors in GH-deficient adults: A meta-analysis of blinded, randomized, placebo-controlled trials. J Clin Endocrinol Metabol 2004; 89: 2192-9
    CrossrefPubMedGoogle Scholar
  • 31 Møller N, Jørgensen JO. Effects of growth hormone on glucose, lipid, and protein metabolism in human subjects. Endocr Rev 2009; 30: 152-77
    CrossrefPubMedGoogle Scholar
  • 32 Roelfsema F, Veldhuis JD. Growth hormone dynamics in healthy adults are related to age and sex and strongly dependent on body mass index. Neuroendocrinology 2016; 103: 335-44
    CrossrefPubMedGoogle Scholar
  • 33 Laursen T, Gravholt CH, Heickendorff L, Drustrup J, Kappelgaard AM, Jørgensen JO. et al. Long-term effects of continuous subcutaneous infusion versus daily subcutaneous injections of growth hormone (GH) on the insulin-like growth factor system, insulin sensitivity, body composition, and bone and lipoprotein metabolism in GH-deficient adults. J Clin Endocrinol Metab 2001; 86: 1222-8
    PubMedGoogle Scholar
  • 34 Høybye C, Cohen P, Hoffman AR, Ross R, Biller BM, Christiansen JS. Growth Hormone Research Society. Status of long-acting-growth hormone preparations—2015. Growth Horm IGF Res 2015; 25: 201-6
    CrossrefPubMedGoogle Scholar
  • 35 Reiter EO, Attie KM, Moshang Jr T, Silverman BL, Kemp SF, Neuwirth RB. et al Genentech, Inc.-Alkermes, Inc. Collaborative Study Group. A multicenter study of the efficacy and safety of sustained release GH in the treatment of naive pediatric patients with GH deficiency. J Clin Endocrinol Metab 2001; 86: 4700-6
    CrossrefPubMedGoogle Scholar
  • 36 Gazzaruso C, Gola M, Karamouzis I, Giubbini R, Giustina A. Cardiovascular risk in adult patients with growth hormone (GH) deficiency and following substitution with GH–an update. J Clin Endocrinol Metab 2014; 99: 18-29
    CrossrefPubMedGoogle Scholar