Endocrine Abstracts

Background: In the UK, adults with growth hormone deficiency (GHD) are treated with recombinant Growth Hormone (GH) therapy according to NICE guidelines (TA64). Provided that patients show an initial improvement in their quality-of-life score, assessed using the Quality-of-Life Assessment of GHD in Adults (Qol-AGHDA) questionnaire, they can continue with their GH treatment long-term. However, in clinical practice, many patients are observed to discontinue GH replacement on their own accord.

Aim: To identify common reasons for discontinuing GH treatment among patients and propose measures to support planned discontinuation of treatment.

Methods: This service evaluation was conducted in Queen Elizabeth Hospital Birmingham. Data regarding patient demographics, details of GH treatment and metabolic long-term outcomes including cerebrovascular accident, type 2 diabetes mellitus, fragility fractures, myocardial infarction and mortality following GH discontinuation was collected. The reasons for GH discontinuation were analysed among patients who discontinued treatment on their own vs under clinician guidance. The incidence of long-term metabolic outcomes was compared between the 2 groups.

Results: A total of 106 patients were included. 36.8% (n=39) of patients discontinued GH treatment on their own accord. Among patients who discontinued GH replacement on their own, 41% (n=16) did not specify a reason. The patient guided treatment discontinuation group was not observed to be at increased risk of adverse metabolic outcomes compared to patients who discontinued GH treatment under clinician advice.

Recommendations: Patients should be encouraged to consult their clinician if they consider discontinuing GH treatment. Dedicated endocrine nurse support should be available to assess the appropriateness of treatment discontinuation based on patients’ individual circumstances. Clear clinical protocols to facilitate the process of GH discontinuation is necessary.

Conclusion: A significant number of patients on GH replacement undergo unplanned discontinuation of treatment. It is important to establish clear clinical protocols to support and guide treatment discontinuation.