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The relationship between glucocorticoid replacement and quality of life in 2737 hypopituitary patients
Department of Endocrinology, Diabetes and Metabolism, Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Sweden.
Pfizer Endocrine Care, Sollentuna, Sweden.
William Harvey Research Institute, Centre for Clinical Endocrinology, St Bartholomew’s Hospital, Queen Mary, University of London, UK.
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2014 (English)In: European Journal of Endocrinology, ISSN 0804-4643, E-ISSN 1479-683X, Vol. 171, no 5, p. 571-579Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
2014. Vol. 171, no 5, p. 571-579
National Category
Endocrinology and Diabetes
Identifiers
URN: urn:nbn:se:uu:diva-233781DOI: 10.1530/EJE-14-0397ISI: 000344948400012PubMedID: 25127712OAI: oai:DiVA.org:uu-233781DiVA, id: diva2:754282
Available from: 2014-10-10 Created: 2014-10-10 Last updated: 2017-12-05Bibliographically approved

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Koltowska-Häggström, Maria

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