Martel-Duguech Luciana Maria, Jorgensen Jens Otto L, Korbonits Marta, Johannsson Gudmundur, Webb Susan M, Amadidou Fotini, Mintziori G, Arosio Maura, Giavoli Claudia, Badiu Corin, Boschetti Mara, Ferone Diego, Ricci Bitti Silvia, Brue Thierry, Albarel F, Cannavò Salvatore, Cotta Oana Ruxandra, Carvalho Davide, Salazar Daniela, Christ Emanuel, Debono Miguel, Dusek Tina, Garcia-Centeno Rogelio, Ghigo Ezio, Gasco Valentina, Góth Miklós I, Oláh Dóra, Kovacs Laszlo, Höybye Charlotte, Kocjan Tomaz, Mlekuš Kozamernik Katarina, Kužma Martin, Payer Juraj, Medic-Stojanoska Milica, Novak Anela, Miličević Tanja, Pekic Sandra, Miljic Dragana, Perez Luis Jesus, Pico Antonio M, Preda Veronica, Raverot Gerald, Borson-Chazot Francoise, Rochira Vincenzo, Monzani María Laura, Sandahl Kristian, Tsagarakis Stylianos, Mitravela Vana, Zacharieva Sabina, Zilaitiene Birute, Verkauskiene Rasa
L Martel-Duguech, Department of Endocrinology/Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
J Jorgensen, Department of Clinical Medicine - The Department of Endocrinology and Diabetes, University hospital Arhus, Arhus, Denmark.
Eur J Endocrinol. 2020 Dec 1. doi: 10.1530/EJE-20-1180.
Guidelines recommend adults with pituitary disease in whom GH therapy is contemplated, to be tested for GH deficiency (AGHD); however, clinical practice is not uniform.
On-line survey in endocrine centres throughout Europe.
Endocrinologists voluntarily completed an electronic questionnaire regarding AGHD patients diagnosed or treated in 2017-2018.
Twenty-eight centres from 17 European countries participated, including 2139 AGHD patients, 28% of childhood-onset GHD. Aetiology was most frequently non-functioning pituitary adenoma (26%), craniopharyngioma (13%) and genetic/congenital mid-line malformations (13%). Diagnosis of GHD was confirmed by a stimulation test in 52% (GHRH+arginine, 45%; insulin-tolerance, 42%, glucagon, 6%; GHRH alone and clonidine tests, 7%); in the remaining, ≥3 pituitary deficiencies and low serum IGF-I were diagnostic. Initial GH dose was lower in older patients, but only women <26 years were prescribed a higher dose than men; dose titration was based on normal serum IGF-I, tolerance and side-effects. In one country, AGHD treatment was not approved. Full public reimbursement was not available in four countries and only in childhood-onset GHD in another. AGHD awareness was low among non-endocrine professionals and healthcare administrators. Postgraduate AGHD curriculum training deserves being improved.
Despite guideline recommendations, GH replacement in AGHD is still not available or reimbursed in all European countries. Knowledge among professionals and health administrators needs improvement to optimize care of adults with GHD.
指南建议，对于考虑进行生长激素（GH）治疗的垂体疾病成年患者，应进行生长激素缺乏症（AGHD）检测；然而，临床实践并不统一。
1）记录整个欧洲AGHD管理的当前实践情况，并与指南进行对比；2）评估医疗保健专业人员关于AGHD的教育状况。
对欧洲各地内分泌中心进行在线调查。
内分泌学家自愿填写一份关于2017 - 2018年诊断或治疗的AGHD患者的电子问卷。
来自17个欧洲国家的28个中心参与了调查，包括2139例AGHD患者，其中28%为儿童期起病的生长激素缺乏症（GHD）。病因最常见的是非功能性垂体腺瘤（26%）、颅咽管瘤（13%）和遗传性/先天性中线畸形（13%）。52%的患者通过刺激试验确诊为GHD（生长激素释放激素+精氨酸，45%；胰岛素耐量试验，42%，胰高血糖素试验，6%；单独使用生长激素释放激素和可乐定试验，7%）；其余患者中，≥3种垂体功能减退和低血清胰岛素样生长因子-I（IGF-I）可作为诊断依据。老年患者的初始GH剂量较低，但只有年龄<26岁的女性患者的处方剂量高于男性；剂量滴定基于正常血清IGF-I、耐受性和副作用。在一个国家，AGHD治疗未获批准。在四个国家，全额公共报销不可用，在另一个国家仅儿童期起病的GHD可报销。非内分泌专业人员和医疗保健管理人员对AGHD的认知度较低。研究生阶段的AGHD课程培训有待改进。
尽管有指南建议，但并非所有欧洲国家都能提供AGHD的GH替代治疗或予以报销。专业人员和卫生管理人员的知识水平有待提高，以优化对成年GHD患者的护理。
