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Update in Mortality in GH treated patients.

Erfurth, Eva Marie LU (2013) In Journal of Clinical Endocrinology and Metabolism 98(11). p.4219-4226
Abstract
During GH therapy for 2.3-9.6 years a male adult onset (AO) GH deficient (GHD) patient with a diagnosis of a non-functioning adenoma, have no increased all-cause mortality. However, women with AO GHD are still at a slightly higher risk. This general improvement in mortality is due to; more contemporary regiment of cardiovascular drugs, a refinement of surgical procedures, besides GH therapy improved hormone replacement regimens with lowered glucocorticoid replacement, and updated approaches of sex steroids for women, and less use of cranial radiotherapy. The underlying disease is the most important predictor for mortality: e.g. a craniopharyngioma, malignant causes of hypopituitarism, previous Cushing's disease, presence of diabetes... (More)
During GH therapy for 2.3-9.6 years a male adult onset (AO) GH deficient (GHD) patient with a diagnosis of a non-functioning adenoma, have no increased all-cause mortality. However, women with AO GHD are still at a slightly higher risk. This general improvement in mortality is due to; more contemporary regiment of cardiovascular drugs, a refinement of surgical procedures, besides GH therapy improved hormone replacement regimens with lowered glucocorticoid replacement, and updated approaches of sex steroids for women, and less use of cranial radiotherapy. The underlying disease is the most important predictor for mortality: e.g. a craniopharyngioma, malignant causes of hypopituitarism, previous Cushing's disease, presence of diabetes insipidus/aggressive tumors. The main cause of increased mortality was cerebrovascular diseases and of infectious/repiratory diseases in ACTH deficient patients. Further, there was a significant impact of young age at disease onset and of death from secondary brain tumors, with a higher risk after cranial radiotherapy.Four cohorts of GH treated childhood onset (CO) GHD patients have been published. Two of them included only patients with idiopathic isolated GH deficiency (IGHD), neurosecretory dysfunction, idiopathic short stature (ISS) or born short for gestational age (SGA). Increased mortality in circulatory disorders, ill defined diseases and bone cancer was recorded in one, but not in the other smaller study, where suicide and accidents caused the majority of deaths. A third CO GHD cohort included patients with a background of malignant tumors, craniopharyngioma, pituitary adenomas, pituitary aplasia/hypoplasia, and trauma. An increase of all cause mortality was recorded in both males and females. The fourth cohort included IGHD and ISS (60%), but also diagnosis e.g. chronic renal failure, and Turner's syndrome. In these latter studies an underlying serious condition was the most important factor for death, with CNS tumors (recurrent or new tumor) being the leading cause of mortality. (Less)
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organization
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type
Contribution to journal
publication status
published
subject
in
Journal of Clinical Endocrinology and Metabolism
volume
98
issue
11
pages
4219 - 4226
publisher
The Endocrine Society
external identifiers
  • wos:000327180700026
  • pmid:24030944
  • scopus:84887438134
ISSN
1945-7197
DOI
10.1210/jc.2013-2415
language
English
LU publication?
yes
id
52126498-85a7-4ab4-930d-dd650c46486f (old id 4065919)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/24030944?dopt=Abstract
date added to LUP
2013-10-02 11:57:34
date last changed
2019-02-20 02:39:29
@article{52126498-85a7-4ab4-930d-dd650c46486f,
  abstract     = {During GH therapy for 2.3-9.6 years a male adult onset (AO) GH deficient (GHD) patient with a diagnosis of a non-functioning adenoma, have no increased all-cause mortality. However, women with AO GHD are still at a slightly higher risk. This general improvement in mortality is due to; more contemporary regiment of cardiovascular drugs, a refinement of surgical procedures, besides GH therapy improved hormone replacement regimens with lowered glucocorticoid replacement, and updated approaches of sex steroids for women, and less use of cranial radiotherapy. The underlying disease is the most important predictor for mortality: e.g. a craniopharyngioma, malignant causes of hypopituitarism, previous Cushing's disease, presence of diabetes insipidus/aggressive tumors. The main cause of increased mortality was cerebrovascular diseases and of infectious/repiratory diseases in ACTH deficient patients. Further, there was a significant impact of young age at disease onset and of death from secondary brain tumors, with a higher risk after cranial radiotherapy.Four cohorts of GH treated childhood onset (CO) GHD patients have been published. Two of them included only patients with idiopathic isolated GH deficiency (IGHD), neurosecretory dysfunction, idiopathic short stature (ISS) or born short for gestational age (SGA). Increased mortality in circulatory disorders, ill defined diseases and bone cancer was recorded in one, but not in the other smaller study, where suicide and accidents caused the majority of deaths. A third CO GHD cohort included patients with a background of malignant tumors, craniopharyngioma, pituitary adenomas, pituitary aplasia/hypoplasia, and trauma. An increase of all cause mortality was recorded in both males and females. The fourth cohort included IGHD and ISS (60%), but also diagnosis e.g. chronic renal failure, and Turner's syndrome. In these latter studies an underlying serious condition was the most important factor for death, with CNS tumors (recurrent or new tumor) being the leading cause of mortality.},
  author       = {Erfurth, Eva Marie},
  issn         = {1945-7197},
  language     = {eng},
  number       = {11},
  pages        = {4219--4226},
  publisher    = {The Endocrine Society},
  series       = {Journal of Clinical Endocrinology and Metabolism},
  title        = {Update in Mortality in GH treated patients.},
  url          = {http://dx.doi.org/10.1210/jc.2013-2415},
  volume       = {98},
  year         = {2013},
}