Impact of NICE guidelines for adult growth hormone replacement on practice in Scotland

Sam Philip; Isabel Howat; Maggie Carson; Anne Booth; Catherine Patterson; Christopher Schofield; Alan Patrick; Graham Leese; John Bevan; John Connell

P95

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Endocrine Abstracts (2008) 15 P95

SFEBES2008 Poster Presentations Clinical practice/governance and case reports (86 abstracts)

Impact of NICE guidelines for adult growth hormone replacement on practice in Scotland

Sam Philip ¹ , Isabel Howat ⁴ , Maggie Carson ⁵ , Anne Booth ¹ , Catherine Patterson ³ , Christopher Schofield ³ , Alan Patrick ⁵ , Graham Leese ³ , John Bevan ¹ & John Connell ²

Err

Author affiliations

¹Aberdeen Royal Infirmary, Aberdeen, UK; ²Glasgow Cardiovascular Research Centre, Glasgow, UK; ³Ninewells Hospital, Dundee, UK; ⁴Victoria Infirmary, Glasgow, UK; ⁵Royal Infirmary of Edinburgh, Edinburgh, UK.

Aim: To assess whether adults in Scotland currently receiving growth hormone (GH) meet the NICE criteria for starting and continuing GH replacement.

Methods: We surveyed all endocrinologists in Scotland and identified the main centres using GH replacement. A cross-sectional case note review was carried out of all patients commenced on GH.

Results: About 208 patients (51% women; 24% professionals, 90% Caucasian) were identified, 69 of whom started GH therapy after publication of the NICE criteria in August 2003. Tumours in the sellar region were the main cause of GH deficiency. All patients had baseline pituitary testing and were on other pituitary hormone replacements (thyroxine, 83%; hydrocortisone, 78%; testosterone, 71% men; oestrogens, 46% women; DDAVP, 24%). Ninety percent of patients had a dynamic GH stimulation test and 88% had a peak GH level below the recommended threshold (9 mU/l). Fifty-three patients (77%) had an AGHDA score >11 documented before commencing GH post-NICE compared with 35 (25%) pre-NICE. Only 39 patients (18%) met the full NICE criteria for starting and continuing GH (pre-NICE, 11%; post-NICE, 35%).

Conclusion: Although the use of quality of life assessments has increased after the release of the NICE guidelines, most patients in Scotland on GH do not satisfy the full set of NICE criteria.