Endocrine Abstracts

Hypopituitarism is associated with profound androgen deficiency, even in patients who are adrenocorticotrophic hormone (ACTH) replete. DHEA has been shown to have a beneficial effect on well-being in patients with adrenal failure. We hypothesised that DHEA may be additive to the known effects of GH on psychological well-being in patients with hypopituitarism. In a double blind placebo controlled trial 50 mg DHEA or placebo was added to standard replacement, including growth hormone, over 6 months, followed by open phase 6 months DHEA replacement. Primary end points were quality of life and libido. Thirty female and 21 male hypopituitary patients on stable GH and other hormone replacement as indicated, were enrolled. All males and 18/30 females were on gonadal steroid replacement. Serum IGF-I was maintained constant by 4 weekly GH dose adjustments. Psychological well-being was assessed using the QoL-AGHDA, GHQ, SF36 and EQ5D (Euroqol) and libido using SSES-E. Patients had impaired psychological well-being compared to the British population at baseline. Females showed an improvement after 6 months in Qol-AGHDA [−2.9±2.8 (mean±S.D.) (DHEA) vs. −0.53±3 (placebo); P<0.05: 95% CI 0.06, 4.71], SF36 general health perception [9.6±14.2 (DHEA) vs. −1.2±11.6 (placebo); P=0.036: 95% CI −20.8, −0.7] and SF36 social functioning scores [14.6±23.1 (DHEA) vs. −4.7±25 (placebo); P=0.047: 95% CI −38.3, −0.3]. Males showed an improvement after 6 months in GHQ self-esteem [−1.3±1.7 (DHEA) vs. (0.5±1.5) (placebo); P=0.03: 95% CI 0.16, 3.34] and depression [−1.6±2.2 (DHEA) vs. 1.2±2.4 (placebo); P=0.02: 95% CI 0.5, 5.15] scores. There was no effect on libido evident. 71% of women and 48% of men chose to continue DHEA after the trial period. Our data demonstrate psychological benefit of DHEA in addition to conventional hormone replacement including GH and, in addition, confirm the utility of QoL-AGHDA in a placebo-controlled setting.