Patient Area Endocrinology and Nephrology, Inflammation and Infection Theme, Karolinska University Hospital and Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.
Department of Endocrinology, Skåne University Hospital, University of Lund, Lund, Sweden.
Eur J Endocrinol. 2019 Dec;181(6):629-638. doi: 10.1530/EJE-19-0576.
Clinical observations over time of adults with growth hormone (GH) deficiency (GHD) have indicated a shift in patient characteristics at diagnosis. The objective of this study was to compare baseline characteristics of patients diagnosed with adult-onset GHD naive to GH replacement during three study periods (1994-1999 (P1), 2000-2004 (P2), and 2005-2012 (P3)) using the KIMS (Pfizer's International Metabolic) database.
Data were retrieved for a total of 6069 patients with adult-onset GHD from six countries (Belgium, Germany, Netherlands, Spain, Sweden, and UK): P1 (n = 1705), P2 (n = 2397), and P3 (n = 1967).
The proportions of patients with pituitary/hypothalamic tumors and patients with multiple pituitary hormone deficiencies decreased per entry year period, while the proportions with hypertension and diabetes increased. The lag time from diagnosis of pituitary disease to start of GH treatment decreased by 2.9 years over the entry year periods. IGF-1 increased by 0.1 standard deviation score per entry year period. Maximum GH following various stimulation tests, BMI, and waist circumference increased. The use of radiotherapy, glucocorticoid replacement doses, and the proportion of women >50 years on estrogen replacement therapy decreased. The effects of 1 year of GH replacement were similar over the entry year periods despite changes in the patients' baseline characteristics. An expected increase in fasting blood glucose was seen after 1 year of GH treatment.
The degree of confirmed GHD became less pronounced and more patients with co-morbidities and diabetes were considered for GH replacement therapy, possibly reflecting increased knowledge and confidence in GH therapy gained with time.
对长期患有生长激素（GH）缺乏症（GHD）的成年人的临床观察表明，在诊断时患者的特征发生了变化。本研究的目的是使用 KIMS（辉瑞国际代谢）数据库比较三个研究期间（1994-1999 年（P1）、2000-2004 年（P2）和 2005-2012 年（P3））新诊断为成人起病 GHD 且未接受 GH 替代治疗的患者的基线特征。
从六个国家（比利时、德国、荷兰、西班牙、瑞典和英国）共检索到 6069 名成年起病 GHD 患者的数据：P1（n=1705）、P2（n=2397）和 P3（n=1967）。
随着入组年份的增加，垂体/下丘脑肿瘤患者和多种垂体激素缺乏患者的比例逐渐降低，而高血压和糖尿病患者的比例逐渐增加。从垂体疾病诊断到开始 GH 治疗的时间间隔缩短了 2.9 年。IGF-1 随着入组年份的增加而增加了 0.1 个标准差评分。各种刺激试验后的 GH 最大值、BMI 和腰围增加。放疗、糖皮质激素替代剂量的使用以及 50 岁以上接受雌激素替代治疗的女性比例降低。尽管患者的基线特征发生了变化，但 GH 替代治疗 1 年后的效果在入组年份期间仍相似。GH 治疗 1 年后空腹血糖水平预计会升高。
确诊的 GHD 程度变得不那么明显，更多合并症和糖尿病患者被考虑接受 GH 替代治疗，这可能反映了随着时间的推移，对 GH 治疗的认识和信心有所提高。
