Monday, August 17, 2009

From isolated growth hormone deficiency to multiple pituitary hormone deficiency: an evolving continuum. A KIMS analysis

Marianne Klose, Bjorn Jonsson, Roger Abs, Vera Popovic, Maria Koltowska-Haggstrom, Bernhard Saller, Ulla Feldt-Rasmussen and Ione Kourides

M Klose, Endocrinology, Rigshospitalet, Copenhagen, 2100, Denmark
B Jonsson, Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
R Abs, Endocrinology, University of Antwerp, Wilrijk, Belgium
V Popovic, Neuroendocrine Unit, Endocrinology, Belgrade, Serbia
M Koltowska-Haggstrom, KIGS/KIMS/ACROSTUDY Medical Outcomes, Pfizer Endocrine Care, Sollentuna, Sweden
B Saller, Endocrine Care, Pfizer Ltd., Tadworth, United Kingdom
U Feldt-Rasmussen, Dept of Endocrinology P, Rigshospitalet, Copenhagen, Denmark
I Kourides, 7Global Endocrine Care, Pfizer Inc, New York, United States

Correspondence: Marianne Klose, Email:

Objective: To describe baseline clinical presentation, treatment effects, and evolution of isolated growth hormone deficiency (iGHD) to multiple pituitary hormone deficiency (MPHD) in adult-onset (AO) GHD.

Design: Observational prospective study.

Methods: Baseline characteristics were recorded in 4110 patients with organic AO-GHD, who were GH naïve prior to entry into KIMS (Pfizer International Metabolic Database)(283 (7%) iGHD, 3827 MPHD). The effect of GH replacement after two years was assessed in those with available follow-up data (133 iGHD, 2207 MPHD), and development of new deficiencies in those with available data on concomitant medication (165 iGHD, 3006 MPHD).

Results: iGHD and MPHD patients had similar baseline clinical presentation, and both groups responded similarly to 2 years of GH therapy, with favourable changes in lipid profile and improved QoL.

New deficiencies were observed in 35% of iGHD patients, which was similar to MPHD patients with one additional deficit other than GH. New deficiencies most often presented within the first year but were observed up to 6 years after GH commencement. Conversion of iGHD into MPHD was not predicted by etiology, baseline characteristics, surgery or radiotherapy, whereas in MPHD additional deficits was predicted by age (p<0.001) and pituitary disease duration (p<0.003).

Conclusion: Both AO-iGHD and -MPHD patients have similar baseline clinical presentation and respond equally well to 2 yrs of GH replacement. Hypopituitarism in adults seems to be a dynamic condition where new deficiencies can appear years from the initial diagnosis, and careful endocrine follow-up of all hypopituitary patients, including those with iGHD, is warranted.