Meta-analysis of mortality in adults with growth hormone deficiency: Does growth hormone replacement therapy really improve mortality rates?

Autor: van Bunderen CC; Division of Endocrinology, Department of Internal Medicine, Radboud University Medical Center, Nijmegen 6525 GA, the Netherlands. Electronic address: Christa.vanBunderen@radboudumc.nl., Olsson DS; Department of Medicine, Sahlgrenska University Hospital, 413 46 Gothenburg, Sweden; Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden; Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden. Electronic address: daniel.olsson@gu.se.
Jazyk: angličtina
Zdroj: Best practice & research. Clinical endocrinology & metabolism [Best Pract Res Clin Endocrinol Metab] 2023 Dec; Vol. 37 (6), pp. 101835. Date of Electronic Publication: 2023 Oct 23.
DOI: 10.1016/j.beem.2023.101835
Abstrakt: Growth hormone (GH) deficiency (GHD) is one of the most prevalent deficiencies in patients with hypopituitarism and several cohort studies have demonstrated an increased mortality risk in hypopituitary patients with a presumed GHD. The cause of the excess mortality is most likely multifactorial, including the etiology of the hypopituitarism, non-physiological replacement therapies (mostly glucocorticoid), tumor treatment and its side effects as well as untreated GHD. Several years later, other cohort studies that investigated life expectancy in patients with hypopituitarism on GH replacement therapy (GHRT) that showed a normalized mortality. By comparison of the distribution of characteristics of interest between cohorts, we discuss the existing literature to answer the following question: does growth hormone replacement really improve mortality rates in adult patients with hypopituitarism and GHD? We also conducted a meta-analysis of these studies. Since the literature suffers from selection and time bias (improvement of tumor management and other pituitary hormone replacement therapies), there is no high-quality evidence that replacement therapy for GHD really improves mortality. However, the available data does suggest that GHRT plays a significant part in the normalization of the mortality in patients with hypopituitarism.
Competing Interests: Declaration of Competing Interest DSO has served as a consultant for Ipsen, Pfizer, NovoNordisk, and Sandoz; has received research grants from Sandoz and Pfizer; and is an employee at AstraZeneca as of 30 August 2021. CCvB has no disclosures to report.
(Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
Databáze: MEDLINE
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