Oskar Ragnarsson1, Anders F Mattsson2, John P Monson2, Helena Filipsson Nyström2, Ann-Charlotte Åkerblad2, Maria Kołtowska-Häggström2, Gudmundur Johannsson2. 1. Department of EndocrinologyDiabetes and Metabolism, Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gröna Stråket 8, SE-413 45 Gothenburg, SwedenPfizer Endocrine CareSollentuna, SwedenWilliam Harvey Research InstituteCentre for Clinical Endocrinology, St Bartholomew's Hospital, Queen Mary, University of London, London, UKDepartment of Women's and Children's HealthUppsala University, Uppsala, Sweden oskar.ragnarsson@medic.gu.se. 2. Department of EndocrinologyDiabetes and Metabolism, Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gröna Stråket 8, SE-413 45 Gothenburg, SwedenPfizer Endocrine CareSollentuna, SwedenWilliam Harvey Research InstituteCentre for Clinical Endocrinology, St Bartholomew's Hospital, Queen Mary, University of London, London, UKDepartment of Women's and Children's HealthUppsala University, Uppsala, Sweden.
Abstract
OBJECTIVE: Quality of life (QoL) is impaired in hypopituitary patients and patients with primary adrenal insufficiency. The aim of this study was to analyse the impact of glucocorticoid (GC) replacement on QoL. The main hypothesis was that ACTH-insufficient patients experience a dose-dependent deterioration in QoL. DESIGN, PATIENTS AND METHODS: This was a retrospective analysis of data from KIMS (Pfizer International Metabolic Database). Data from 2737 adult GH-deficient (GHD) hypopituitary patients were eligible for analysis. Thirty-six per cent were ACTH sufficient and 64% ACTH insufficient receiving a mean±s.d. hydrocortisone equivalent (HCeq) dose of 22.3±8.7 mg (median 20.0). QoL at baseline and 1 year after commencement of GH replacement was assessed by the QoL-assessment of GHD in adults. RESULTS: At baseline, no significant difference in QoL was observed between ACTH-sufficient and -insufficient patients. Increasing HCeq dose was associated with worse QoL. Patients on HCeq≤10 mg had the best and patients receiving ≥25 mg demonstrated the poorest QoL. At 1 year of GH replacement, the improvement in QoL did not differ between ACTH-sufficient and -insufficient patients, and no association was observed between HCeq dose and QoL improvement. CONCLUSION: Adult hypopituitary patients with untreated GHD receiving GC replacement have similar QoL as ACTH-sufficient patients. Among ACTH-insufficient patients, there is a dose-dependent association between increasing dose and impaired QoL. This association may be explained by supraphysiological GC exposure although it remains plausible that clinicians may have increased GC doses in order to address otherwise unexplained QoL deficits.
OBJECTIVE: Quality of life (QoL) is impaired in hypopituitary patients and patients with primary adrenal insufficiency. The aim of this study was to analyse the impact of glucocorticoid (GC) replacement on QoL. The main hypothesis was that ACTH-insufficientpatients experience a dose-dependent deterioration in QoL. DESIGN, PATIENTS AND METHODS: This was a retrospective analysis of data from KIMS (Pfizer International Metabolic Database). Data from 2737 adult GH-deficient (GHD) hypopituitarypatients were eligible for analysis. Thirty-six per cent were ACTH sufficient and 64% ACTH insufficient receiving a mean±s.d. hydrocortisone equivalent (HCeq) dose of 22.3±8.7 mg (median 20.0). QoL at baseline and 1 year after commencement of GH replacement was assessed by the QoL-assessment of GHD in adults. RESULTS: At baseline, no significant difference in QoL was observed between ACTH-sufficient and -insufficientpatients. Increasing HCeq dose was associated with worse QoL. Patients on HCeq≤10 mg had the best and patients receiving ≥25 mg demonstrated the poorest QoL. At 1 year of GH replacement, the improvement in QoL did not differ between ACTH-sufficient and -insufficientpatients, and no association was observed between HCeq dose and QoL improvement. CONCLUSION: Adult hypopituitary patients with untreated GHD receiving GC replacement have similar QoL as ACTH-sufficient patients. Among ACTH-insufficientpatients, there is a dose-dependent association between increasing dose and impaired QoL. This association may be explained by supraphysiological GC exposure although it remains plausible that clinicians may have increased GC doses in order to address otherwise unexplained QoL deficits.
Authors: M Maccario; R Giordano; V Gasco; J Giannelli; L Campioni; E Arvat; E Ghigo; S Grottoli Journal: J Endocrinol Invest Date: 2022-10-17 Impact factor: 5.467
Authors: Elise Rousseau; Michael Joubert; Géraldine Trzepla; Jean Jacques Parienti; Thomas Freret; Marie Christine Vanthygem; Rachel Desailloud; Hervé Lefebvre; Antoine Coquerel; Yves Reznik Journal: PLoS One Date: 2015-08-28 Impact factor: 3.240
Authors: S Puglisi; A Rossini; I Tabaro; S Cannavò; F Ferrau'; M Ragonese; G Borretta; M Pellegrino; F Dughera; A Parisi; A Latina; A Pia; M Terzolo; G Reimondo Journal: J Endocrinol Invest Date: 2020-08-10 Impact factor: 4.256