Appelman-Dijkstra NM, Rijndorp M, Biermasz NR, Dekkers OM, Pereira AM. Effects of discontinuation of growth hormone replacement in adult GH deficient patients: a cohort study and systematic review of literature. European Journal of Endocrinology. Effects of discontinuation of growth hormone replacement in adult GH deficient patients: a cohort study and systematic review of literature.
Background: Recombinant human Growth Hormone(rhGH) replacement is advocated in adult growth hormone deficient(GHD) patients to increase bone mass, improve lipid profile, body composition, and quality of life. The long-term effects of discontinuation of rhGh replacement are unknown.
Methods: Cohort study and systematic review, aimed at evaluation of the long-term metabolic effects of discontinuation of rhGh replacement in adult GHD patients, with a subgroup analyses according to age(<or> 60 years). Data on anthropometry, lipids, glucose, and bone mass density(BMD) were assessed for 3 years after discontinuation.
Results:
Cohort study: Sixty-four patients who had discontinued rhGh for>12 months were included. Fat percentage increased from 31.5±9.5% to 33.8±9.0%(mean difference 2.3,p=0.003). BMI decreased in subjects <60 years only(p=0.014). Glucose, Total- and LDL-cholesterol levels did not change, but the percentage of patients on statins increased slightly from 39% to 44%. HDL-C concentration increased only in patients <60 years(mean difference 0.2,p=0.043). Lumbar spine BMD did not change, but femoral neck BMD and bone turnover markers decreased in subjects<60 years(p=0.001).
Systematic review: The systematic review included 8 studies(n=166 patients) with a follow up duration of 6-18 months. Three studies qualified as low risk of bias, and 5 studies as having an intermediate risk of bias. None of the studies reported handling of statins, bisphosphonates, and glucose lowering medication or excluded patients using these medications.
Conclusions: In this study, discontinuation of rhGh replacement resulted in metabolic changes only in patients < 60 years after 3 years. Further research is warranted to determine optimal strategies for (dis)continuation of rhGh replacement in adult patients with GHD.
Background: Recombinant human Growth Hormone(rhGH) replacement is advocated in adult growth hormone deficient(GHD) patients to increase bone mass, improve lipid profile, body composition, and quality of life. The long-term effects of discontinuation of rhGh replacement are unknown.
Methods: Cohort study and systematic review, aimed at evaluation of the long-term metabolic effects of discontinuation of rhGh replacement in adult GHD patients, with a subgroup analyses according to age(<or> 60 years). Data on anthropometry, lipids, glucose, and bone mass density(BMD) were assessed for 3 years after discontinuation.
Results:
Cohort study: Sixty-four patients who had discontinued rhGh for>12 months were included. Fat percentage increased from 31.5±9.5% to 33.8±9.0%(mean difference 2.3,p=0.003). BMI decreased in subjects <60 years only(p=0.014). Glucose, Total- and LDL-cholesterol levels did not change, but the percentage of patients on statins increased slightly from 39% to 44%. HDL-C concentration increased only in patients <60 years(mean difference 0.2,p=0.043). Lumbar spine BMD did not change, but femoral neck BMD and bone turnover markers decreased in subjects<60 years(p=0.001).
Systematic review: The systematic review included 8 studies(n=166 patients) with a follow up duration of 6-18 months. Three studies qualified as low risk of bias, and 5 studies as having an intermediate risk of bias. None of the studies reported handling of statins, bisphosphonates, and glucose lowering medication or excluded patients using these medications.
Conclusions: In this study, discontinuation of rhGh replacement resulted in metabolic changes only in patients < 60 years after 3 years. Further research is warranted to determine optimal strategies for (dis)continuation of rhGh replacement in adult patients with GHD.
