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Changing Patterns of the Adult Growth Hormone Deficiency Diagnosis Documented in a Decade-Long Global Surveillance Database

Hospital Santa Creu i Sant Pau (S.M.W.), Autonomous University of Barcelona and Centro de Investigación Biomédica en Red Unit 747, Barcelona, Spain; Charité-Universitätsmedizin (C.J.S.), Campus Mitte, D-10117 Berlin, Germany; Lilly Research Laboratories (D.M., M.L.H.), Eli Lilly and Company, Indianapolis, Indiana 46285; Cedars-Sinai Medical Center (S.M.), Los Angeles, California 90048; Lilly Research GmbH (H.J., W.F.B.), Eli Lilly and Company, D-61350 Bad Homburg, Germany; and Cascina del Rosone (A.F.A.), 14041 Agliano Terme, Italy

Address all correspondence and requests for reprints to: Susan Webb, Department of Endocrinology, Hospital Santa Creu i Sant Pau, Autonomous University of Barcelona, Pare Claret 167, 08025 Barcelona, Spain. E-mail: swebb{at}santpau.cat.

Background: GH therapy in adult patients with GH deficiency (GHD) was approved over 10 yr ago, and the indication has subsequently gained broad acceptance. The HypoCCS surveillance database is a suitable means to examine the evolution of diagnostic patterns since 1996.

Methods: Baseline demographics, reported cause of GHD, and diagnostic tests were available from 5893 GH-treated patients. Trends for change over time in diagnosis, GH stimulation test data, and IGF-I measurements were analyzed at 2-yr intervals by linear regression models, with entry year as the predictive variable.

Results: Over the decade, there was a decrease in patients enrolled with diagnoses of pituitary adenoma (50.2 to 38.6%; P < 0.001), craniopharyngioma (13.3 to 8.4%; P = 0.005) and pituitary hemorrhage (5.8 to 2.8%; P = 0.001); increases in idiopathic GHD (13.9 to 19.3%; P < 0.001), less common diagnoses (7.4 to 15.8%; P < 0.001), and undefined/unknown diagnoses (1.3 to 8.6%; P < 0.001) were observed. Use of arginine, clonidine, and L-dopa tests declined, whereas use of the GHRH-arginine test increased. Median values for peak GH from all tests except GHRH-arginine and for IGF-I SD scores increased significantly (P < 0.001). Over the decade (1996–2005), idiopathic GHD was reported for 16.7% of patients, and more than half of these had adult onset GHD. In the idiopathic adult onset group, 40.2% had isolated GHD; 18.3 and 4.4% had a stimulation test GH peak of at least 3.0 and 5.0 µg/liter, respectively.

Conclusions: Significant shifts in diagnostic patterns have occurred since approval of the adult GHD indication, with a trend to less severe forms of GHD.

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