Exp Clin Endocrinol Diabetes 2012; 120 - P4
DOI: 10.1055/s-0032-1330089

Growth hormone replacement in adults with severe growth hormone deficiency is effective even if baseline IGF-1 levels are in the normal range

M Faust 1, AC Åkerblad 2, M Buchfelder 3, G Johannsson 4, P Jonsson 2, P Kann 5, P Touraine 6, M Koltowska Häggström 2
  • 1Center for Endocrinology, Diabetes and Preventive Medicine, University of Cologne, Germany
  • 2KIMS Medical Outcomes, Pfizer Endocrine Care, Sollentuna, Sweden
  • 3Department of Neurosurgery, University of Erlangen-Nuremberg, Erlangen, Germany
  • 4Department of Endocrinology, Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Sweden
  • 5Department of Endocrinology and Diabetes, Philipps University, Marburg, Germany
  • 6Hôpital de la Pitié-Salpêtrière, Paris, France

Replacement of human growth hormone (GH) in adults with severe adult growth hormone deficiency (GHD) is associated with improvement in quality of life, body composition, bone mineral density and lipid profile. IGF-1 levels below the normal range are used as a screening tool to identify patients with GHD and it is recommended to titrate the GH dose to achieve normal IGF-1 levels. However, IGF-1 levels in the normal range do not exclude severe GHD. Up to now it is not clear whether patients with normal IGF-1 levels prior to replacement therapy will benefit from GH therapy. Therefore we analysed the KIMS international database and identified 575 patients with IGF-1 levels in the normal range (-2 SDS to +2 SDS) before treatment (Group NIB) and compared those with 271 patients with low IGF-1 levels (< -2 SDS) at baseline (Group LIB). There was no significant difference regarding gender distribution in the two groups. The percentage of childhood onset of GHD was significantly higher in the LIB group (35% vs. 4%). The medium age of entering into KIMS was 38,8 years in the LIB group versus 49,0 years in the NIB group. Baseline medium height was significantly lower in the LIB group (167.7cm vs. 170.7cm) while there were no significant differences regarding BMI and waist to hip ratio. The GH starting dose did not differ between the groups, however after one year the medium dose in the NIB group was significantly lower (0.3mg/d vs. 0.42mg/d). Disease specific quality of life measured by Quality of Life-Assessment of Growth Hormone Deficiency in Adults (QoL-AGHDA) was worse in the NIB group (13 vs. 10.25). After one year of treatment QoL-AGHDA Score improved in both groups, however the improvement in the NIB group was even higher (-4.41 vs. -3.52). The results of this analysis show that GH replacement therapy is effective even if IGF-1 levels prior to treatment are in the normal range.