Adnan Ajmal1, Erin McKean2,3, Stephen Sullivan3, Ariel Barkan4,5. 1. Division of Metabolism, Endocrinology and Diabetes, Department of Medicine, University of Michigan, 24 Frank Lloyd Wright Drive, G-1500, Ann Arbor, MI, 48106, USA. 2. Department of Otolaryngology, University of Michigan, Ann Arbor, MI, USA. 3. Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA. 4. Division of Metabolism, Endocrinology and Diabetes, Department of Medicine, University of Michigan, 24 Frank Lloyd Wright Drive, G-1500, Ann Arbor, MI, 48106, USA. abarkan@umich.edu. 5. Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA. abarkan@umich.edu.
Abstract
PURPOSE:Hypopituitary patients are assumed to have decreased QoL due to GHD. However, in placebo controlled trials, the effects of GH replacement are no different from placebo. Hydrocortisone dose > 20 mg/day and pituitary radiation are independently associated with poorer QoL. We assessed QoL in panhypopituitary GH- deficient patients never treated with GH. METHODS: Study group was divided into: (a) surgery followed by radiation (n = 21) and (b) surgery alone (n = 32). Mean duration of GHD was 71.4 ± 7.8 months and mean daily hydrocortisone dose was 15 ± 0.7 mg. Control group had transnasal surgery for benign sinus conditions (n = 54). RESULTS:AGHDA scores were significantly worse in the entire study group compared to controls (8.1 ± 1.0 vs. 5.1 ± 0.9, p = 0.03). In patients with history of radiation therapyAGHDA scores were significantly worse than in controls (9.1 ± 1.5, p = 0.02) and SNOT-22 (Sino-Nasal Outcome Test) scores were also significantly worse (15.8 ± 2.0 vs. 23.2 ± 3.5, p = 0.04). However, AGHDA scores in patients without history of radiation and on "physiological" dose of hydrocortisone were similar to those in controls (5.1 ± 0.9 vs. 7.3 ± 1.3, p = 0.17). CONCLUSIONS: Replacement with hydrocortisone doses not exceeding 20 mg/day and avoidance of radiation therapy was accompanied by normal QoL in patients not replaced with GH. Thus, we suggest that the decreased QoL in hypopituitary patients may not be due to GH deficiency per se, but rather to high hydrocortisone doses and to aftereffects of cranial radiation.
RCT Entities:
PURPOSE: Hypopituitary patients are assumed to have decreased QoL due to GHD. However, in placebo controlled trials, the effects of GH replacement are no different from placebo. Hydrocortisone dose > 20 mg/day and pituitary radiation are independently associated with poorer QoL. We assessed QoL in panhypopituitary GH- deficientpatients never treated with GH. METHODS: Study group was divided into: (a) surgery followed by radiation (n = 21) and (b) surgery alone (n = 32). Mean duration of GHD was 71.4 ± 7.8 months and mean daily hydrocortisone dose was 15 ± 0.7 mg. Control group had transnasal surgery for benign sinus conditions (n = 54). RESULTS: AGHDA scores were significantly worse in the entire study group compared to controls (8.1 ± 1.0 vs. 5.1 ± 0.9, p = 0.03). In patients with history of radiation therapy AGHDA scores were significantly worse than in controls (9.1 ± 1.5, p = 0.02) and SNOT-22 (Sino-Nasal Outcome Test) scores were also significantly worse (15.8 ± 2.0 vs. 23.2 ± 3.5, p = 0.04). However, AGHDA scores in patients without history of radiation and on "physiological" dose of hydrocortisone were similar to those in controls (5.1 ± 0.9 vs. 7.3 ± 1.3, p = 0.17). CONCLUSIONS: Replacement with hydrocortisone doses not exceeding 20 mg/day and avoidance of radiation therapy was accompanied by normal QoL in patients not replaced with GH. Thus, we suggest that the decreased QoL in hypopituitary patients may not be due to GH deficiency per se, but rather to high hydrocortisone doses and to aftereffects of cranial radiation.
Authors: Andrew R Hoffman; Beverly M K Biller; David Cook; Joyce Baptista; Bernard L Silverman; Le Dao; Kenneth M Attie; Paul Fielder; Thomas Maneatis; Barbara Lippe Journal: J Clin Endocrinol Metab Date: 2005-09-13 Impact factor: 5.958
Authors: Maria Koltowska-Häggström; Anders F Mattsson; John P Monson; Paul Kind; Xavier Badia; Felipe F Casanueva; Jan Busschbach; Hans P F Koppeschaar; Gudmundur Johannsson Journal: Eur J Endocrinol Date: 2006-07 Impact factor: 6.664
Authors: Jens Bollerslev; Jostein Hallén; Kristian J Fougner; Anders Palmstrøm Jørgensen; Cybele Kristo; Hans Fagertun; Ola Gudmundsen; Pia Burman; Thomas Schreiner Journal: Eur J Endocrinol Date: 2005-09 Impact factor: 6.664
Authors: Andrea S Cornford; Ariel L Barkan; Alexander Hinko; Jeffrey F Horowitz Journal: Am J Physiol Endocrinol Metab Date: 2012-09-25 Impact factor: 4.310
Authors: H B Baum; L Katznelson; J C Sherman; B M Biller; D L Hayden; D A Schoenfeld; K E Cannistraro; A Klibanski Journal: J Clin Endocrinol Metab Date: 1998-09 Impact factor: 5.958
Authors: Anna Aulinas; Nicole Stantonyonge; Apolonia García-Patterson; Juan M Adelantado; Carmen Medina; Juan José Espinós; Esther López; Susan M Webb; Rosa Corcoy Journal: Pituitary Date: 2021-11-30 Impact factor: 4.107