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Overall and cause-specific mortality in GH-deficient adults on GH replacement

Rolf C Gaillard1, Anders F Mattsson, Ann-Charlotte Akerblad

  • 1Department of Endocrinology, Diabetology and Metabolism, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.

European Journal of Endocrinology
|March 30, 2012
PubMed

Insights

Growth hormone (GH) replacement in hypopituitary adults shows a modest increase in mortality, but is lower than previously reported. Adequate IGF1 levels during therapy are linked to reduced mortality from cardiovascular disease and malignancies.

Area of Science:

  • Endocrinology
  • Metabolic Disorders
  • Clinical Research

Background:

  • Hypopituitarism is linked to increased mortality, but underlying factors remain unclear.
  • Growth hormone (GH) deficiency significantly impacts patient health and survival.
  • Understanding mortality risks in GH-replaced hypopituitary patients is crucial.

Purpose of the Study:

  • To evaluate mortality rates and associated factors in a large cohort of hypopituitary patients receiving GH replacement therapy.
  • To investigate the relationship between GH replacement adequacy and mortality outcomes.
  • To identify specific risk factors contributing to increased mortality in this population.

Main Methods:

  • Analysis of data from the Pfizer International Metabolic Database (KIMS) including 13,983 GH-deficient patients.
  • Calculation of standardized mortality ratios (SMRs) using Poisson regression over 69,056 patient-years of follow-up.
  • Assessment of Insulin-like Growth Factor 1 Standard Deviation Score (IGF1 SDS) as a marker for GH replacement adequacy.

Main Results:

  • All-cause mortality was 13% higher than in the general population (SMR=1.13).
  • Factors associated with increased mortality included female gender, younger age, specific diagnoses (Cushing's disease, craniopharyngioma), and diabetes insipidus.
  • Higher IGF1 SDS levels during GH therapy were significantly associated with reduced all-cause mortality and specifically with lower mortality from cardiovascular diseases and malignancies.

Conclusions:

  • GH-replaced hypopituitary patients exhibit a modest increase in mortality, which appears lower than in previously studied GH-deficient populations.
  • Increased mortality risk factors include female gender, younger age, specific underlying conditions, and inadequate GH replacement (lower IGF1 SDS).
  • GH replacement therapy in adults with GH deficiency is considered a safe treatment, with adequate IGF1 levels being a key factor in mitigating mortality risks.
Abstract

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