Endocrine Abstracts

Adult growth hormone deficiency (AGHD) is a metabolic syndrome characterised by osteoporosis, increased visceral fat, adverse lipid profiles, decreased muscle mass and reduced energy levels. As such, it is associated with reduced quality of life (QoL) and increased mortality from cardiovascular disease. Synthetic growth hormone (GH) can be given to replace natural GH; however, treatment is costly at around £3350 per patient per year and could cause side effects including myalgia, fluid retention and carpal tunnel syndrome. NICE therefore limits its use to strict criteria outlined in the technology appraisal TA64. To commence treatment, patients must meet three criteria: have a severe GH deficiency (ITT<3ng/ml or similar test), be treated for co-existing pituitary hormone deficiencies, and if >25 years have an impaired QoL (QoL-AGHDA score ≥11). The guideline further states that treatment must be stopped in patients >25 years after 9 months if there is an insufficient QoL improvement (<7 points QoL-AGHDA). This audit aimed to assess compliance with NICE TA64 at the Queen Elizabeth Hospital, Birmingham between January 2017-December 2021 and identify areas for improvement. Data was collected retrospectively using the trusts electronic records system. Of the 74 patients started on GH, 96% met the criteria for initiating GH. This was likely driven by the need for external verification of the criteria for drug funding. Of patients >25 years of age (n=47), compliance with the re-assessment of QoL following a 9-month GH trial was low, with 68% completing the questionnaire but only 32% completing it within 9 months. Although COVID-19 could have caused disruptions, improvement is needed to prevent potential side effects and costs associated with unwarranted medication. There could be scope for the questionnaire to be completed during face-to-face follow up clinics rather than emailed questionnaires (particularly in patients with reduced access to technology).