Bridging regional and global perspectives

In recent years, medical practice has evolved towards greater reliance on evidence-based medicine. Societies and reimbursement agencies often publish recommendations for treatment based on literature review and trial data. Despite this, growth hormone (GH) replacement therapy in adults varies substantially from region to region. The reasons for this include differing beliefs in quality of life benefits, the cost-effectiveness of GH and the role of GH in reducing cardiovascular mortality. Reimbursement varies from almost complete take-up in Sweden and Germany, to strict guidelines in the UK, while in some countries GH is not reimbursable for adults with GH deficiency, leaving patients open to the short- and long-term consequences of the condition. Clearly, there is a need for further evidence regarding the overall value of GH replacement. Randomized, controlled trials are the foundation of evidence-based medicine, but long-term treatment is difficult to assess in such trials. Thus, there is an important role for large-scale registries in gathering evidence. For example, the MEGHA (Metabolic Endocrinology and Growth Hormone Assessment) database provides participants with a sub- studies function, allowing them to create and design collective, observational studies to investigate areas of GH medicine that are of particular interest or concern to them and their patients.