ECE2011 Poster Presentations Pituitary (111 abstracts)
Does GH replacement therapy reduce mortality in adults with GH deficiency? Data from the Dutch National Registry of GH Treatment in adults
C C van Bunderen 1 , I C van Nieuwpoort 1 , L I Arwert 1 , M W Heymans 1 , A A M Franken 2 , H P F Koppeschaar 3 , A J van der Lely 4, & M L Drent 1
1VU University Medical Center, Amsterdam, The Netherlands; 2Isala Clinics, Zwolle, The Netherlands; 3Emotional Brain and Turing Institute for Multidisciplinary Health Research, Almere, The Netherlands; 4Erasmus Medical Center, Rotterdam, The Netherlands; 5Stichting Aandachtsgebied Endocrinologie and Metabolisme (SAEM), Bergschenhoek, The Netherlands.
Introduction: Adults with GH deficiency (GHD) have a decreased life expectancy due to cardiovascular diseases (CVD). Recombinant GH treatment has made replacement therapy an option in adults with GHD. Data on long-term efficacy and safety are limited and the implication for life expectancy remains to be established.
Methods: The Dutch National Registry of GH Treatment in Adults was founded to gain more insight into long-term efficacy and safety of GH therapy in GHD adults in The Netherlands. A treatment group (n=2229), primary control group (n=109), and secondary control group (n=356) were retrospectively monitored with a median follow up of 6.1 year (interquartile range (IQR) 6.5). Standardized mortality ratios (SMR) for all-cause and cause-specific mortality were calculated. Expected mortality was obtained from cause, sex, calendar year and 5-year age-specific death rates obtained from death and population counts from the Central Bureau of Statistics.
Results: Of the 2694 patients 135 had died at a median age of 62.1 year (IQR 21.6). The SMR for all-cause mortality for men was 1.06 (95% confidence interval (CI) 0.81–1.40) and for women 1.66 (CI 1.23–2.23) in the treatment group. The risk on CVD mortality was increased in women (SMR 2.52; CI 1.57–4.06) and there was no increased risk on cancer mortality in this group. The SMR in the control groups were not significantly elevated. Excluding high-risk patients (possible malignant causes of hypopituitarism) lead to normalization of the SMR for all-cause mortality. The risk on CVD mortality in women remained elevated.
Conclusion: GH deficient women receiving GH treatment have a higher SMR for all-cause mortality than men, which normalized after exclusion of high-risk patients. The risk on CVD mortality remained increased in women. There is no increased risk on cancer mortality in GH treated adults compared to the background population.
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Endocrine Abstracts
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