Department of EndocrinologyDiabetes and Metabolism, Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gröna Stråket 8, SE-413 45 Gothenburg, SwedenPfizer Endocrine CareSollentuna, SwedenWilliam Harvey Research InstituteCentre for Clinical Endocrinology, St Bartholomew's Hospital, Queen Mary, University of London, London, UKDepartment of Women's and Children's HealthUppsala University, Uppsala, Sweden
Department of EndocrinologyDiabetes and Metabolism, Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gröna Stråket 8, SE-413 45 Gothenburg, SwedenPfizer Endocrine CareSollentuna, SwedenWilliam Harvey Research InstituteCentre for Clinical Endocrinology, St Bartholomew's Hospital, Queen Mary, University of London, London, UKDepartment of Women's and Children's HealthUppsala University, Uppsala, Sweden.
Eur J Endocrinol. 2014 Nov;171(5):571-9. doi: 10.1530/EJE-14-0397. Epub 2014 Aug 15.
Quality of life (QoL) is impaired in hypopituitary patients and patients with primary adrenal insufficiency. The aim of this study was to analyse the impact of glucocorticoid (GC) replacement on QoL. The main hypothesis was that ACTH-insufficient patients experience a dose-dependent deterioration in QoL.
DESIGN, PATIENTS AND METHODS: This was a retrospective analysis of data from KIMS (Pfizer International Metabolic Database). Data from 2737 adult GH-deficient (GHD) hypopituitary patients were eligible for analysis. Thirty-six per cent were ACTH sufficient and 64% ACTH insufficient receiving a mean±s.d. hydrocortisone equivalent (HCeq) dose of 22.3±8.7 mg (median 20.0). QoL at baseline and 1 year after commencement of GH replacement was assessed by the QoL-assessment of GHD in adults.
At baseline, no significant difference in QoL was observed between ACTH-sufficient and -insufficient patients. Increasing HCeq dose was associated with worse QoL. Patients on HCeq≤10 mg had the best and patients receiving ≥25 mg demonstrated the poorest QoL. At 1 year of GH replacement, the improvement in QoL did not differ between ACTH-sufficient and -insufficient patients, and no association was observed between HCeq dose and QoL improvement.
Adult hypopituitary patients with untreated GHD receiving GC replacement have similar QoL as ACTH-sufficient patients. Among ACTH-insufficient patients, there is a dose-dependent association between increasing dose and impaired QoL. This association may be explained by supraphysiological GC exposure although it remains plausible that clinicians may have increased GC doses in order to address otherwise unexplained QoL deficits.
生活质量（QoL）在垂体功能减退症患者和原发性肾上腺功能不全患者中受损。本研究旨在分析糖皮质激素（GC）替代对 QoL 的影响。主要假设是，ACTH 不足的患者会出现 QoL 呈剂量依赖性恶化。
设计、患者和方法：这是对 KIMS（辉瑞国际代谢数据库）数据的回顾性分析。共有 2737 名成年生长激素缺乏症（GHD）垂体功能减退症患者的数据符合分析条件。36%的患者 ACTH 充足，64%的患者 ACTH 不足，接受平均±标准差氢化可的松当量（HCeq）剂量为 22.3±8.7mg（中位数 20.0）。使用成人 GH 缺乏症 QoL 评估量表评估基线和开始 GH 替代治疗 1 年后的 QoL。
基线时，ACTH 充足和不足的患者 QoL 无显著差异。HCeq 剂量增加与 QoL 恶化相关。接受 HCeq≤10mg 的患者 QoL 最佳，而接受≥25mg 的患者 QoL 最差。在 GH 替代治疗 1 年后，ACTH 充足和不足的患者 QoL 改善无差异，且 HCeq 剂量与 QoL 改善之间无关联。
接受 GC 替代治疗的未治疗 GHD 成年垂体功能减退症患者的 QoL 与 ACTH 充足的患者相似。在 ACTH 不足的患者中，剂量与 QoL 受损之间存在剂量依赖性关联。这种关联可能是由于 GC 暴露超过生理剂量所致，但也有可能是临床医生为了解决其他无法解释的 QoL 缺陷而增加了 GC 剂量。
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