Changing Patterns of the Adult Growth Hormone Deficiency Diagnosis Documented in a Decade-Long Global Surveillance Database

• Published in: The journal of clinical endocrinology and metabolism 2009-02, Vol.94 (2), p.392-399
• Main Authors: Webb, Susan M., Strasburger, Christian J., Mo, Daojun, Hartman, Mark L., Melmed, Shlomo, Jung, Heike, Blum, Werner F., Attanasio, Andrea F.
• Format: Article
• Language: English
• Subjects: Adult; Age of Onset; Arginine - analysis; Biological and medical sciences; Databases, Factual; Diagnostic Techniques, Endocrine - trends; Endocrinopathies; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Growth Disorders - classification; Growth Disorders - diagnosis; Growth Disorders - epidemiology; Growth Disorders - etiology; Growth Hormone-Releasing Hormone - analysis; Human Growth Hormone - deficiency; Human Growth Hormone - therapeutic use; Humans; Insulin Resistance - physiology; Male; Medical sciences; Middle Aged; Pituitary Diseases - complications; Pituitary Diseases - diagnosis; Population Surveillance - methods; Professional Practice - trends; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.2008-0713

Background: GH therapy in adult patients with GH deficiency (GHD) was approved over 10 yr ago, and the indication has subsequently gained broad acceptance. The HypoCCS surveillance database is a suitable means to examine the evolution of diagnostic patterns since 1996. Methods: Baseline demographics, reported cause of GHD, and diagnostic tests were available from 5893 GH-treated patients. Trends for change over time in diagnosis, GH stimulation test data, and IGF-I measurements were analyzed at 2-yr intervals by linear regression models, with entry year as the predictive variable. Results: Over the decade, there was a decrease in patients enrolled with diagnoses of pituitary adenoma (50.2 to 38.6%; P < 0.001), craniopharyngioma (13.3 to 8.4%; P = 0.005) and pituitary hemorrhage (5.8 to 2.8%; P = 0.001); increases in idiopathic GHD (13.9 to 19.3%; P < 0.001), less common diagnoses (7.4 to 15.8%; P < 0.001), and undefined/unknown diagnoses (1.3 to 8.6%; P < 0.001) were observed. Use of arginine, clonidine, and l-dopa tests declined, whereas use of the GHRH-arginine test increased. Median values for peak GH from all tests except GHRH-arginine and for IGF-I sd scores increased significantly (P < 0.001). Over the decade (1996–2005), idiopathic GHD was reported for 16.7% of patients, and more than half of these had adult onset GHD. In the idiopathic adult onset group, 40.2% had isolated GHD; 18.3 and 4.4% had a stimulation test GH peak of at least 3.0 and 5.0 μg/liter, respectively. Conclusions: Significant shifts in diagnostic patterns have occurred since approval of the adult GHD indication, with a trend to less severe forms of GHD. Significant shifts in diagnostic patterns have occurred since approval of the adult GH deficiency (GHD) indication, with a trend to less severe forms of GHD.