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ESE audit on management of adult growth hormone deficiency in clinical practice

Luciana Martel-Duguech 1 Jens Otto L Jorgensen 2 Márta Korbonits 3 Gudmundur Johannsson 4 Susan Webb 1 F Adamidou 5 G Mintziori 5 M Arosio 6 C Giavoli 6 C Badiu 7 M Boschetti 8 D Ferone 8 S Ricci Bitti 8 Thierry Brue 9, 10, 11 F Albarel 9, 11 S Cannavo 12 G Martino 12 O Cotta 12 D Carvalho 13 D Salazar 13 E Christ 14 M Debono 15 T Dusek 16 R García 17 E Ghigo 18 V Gasco 18 M Goth 19 D Olah 19 L Kovacs 19 C Höybye 20 T Kocjan 21 K Mlekuš Kozamernik 21 M Kužma 22 M Medic Stojanoska 22 A Novak 23 T Miličević 23 S Pekic 24 D Milijic 24 J Perez Luis 25 A Pico 26 V Preda 27 G Raverot 28 F Borson-Chazot 28 V Rochira 29 M Monzani 29 K Sandahl 30 S Tsagarakis 31 V Mitravela 31 S Zacharieva 32 B Zilatiene 33 R Verkauskiene 33
Abstract : Guidelines recommend adults with pituitary disease in whom GH therapy is contemplated, to be tested for GH deficiency (AGHD); however, clinical practice is not uniform. Aims: (1) To record current practice of AGHD management throughout Europe and benchmark it against guidelines; (2) To evaluate educational status of healthcare professionals about AGHD. Design: Online survey in endocrine centres throughout Europe. Patients and methods: Endocrinologists voluntarily completed an electronic questionnaire regarding AGHD patients diagnosed or treated in 2017-2018. Results: Twenty-eight centres from 17 European countries participated, including 2139 AGHD patients, 28% of childhood-onset GHD. Aetiology was most frequently non-functioning pituitary adenoma (26%), craniopharyngioma (13%) and genetic/congenital midline malformations (13%). Diagnosis of GHD was confirmed by a stimulation test in 52% (GHRH+arginine: 45%; insulin-tolerance: 42%, glucagon: 6%; GHRH alone and clonidine tests: 7%); in the remaining, ≥3 pituitary deficiencies and low serum IGF-I were diagnostic. Initial GH dose was lower in older patients, but only women <26 years were prescribed a higher dose than men; dose titration was based on normal serum IGF-I, tolerance and side-effects. In one country, AGHD treatment was not approved. Full public reimbursement was not available in four countries and only in childhood-onset GHD in another. AGHD awareness was low among non-endocrine professionals and healthcare administrators. Postgraduate AGHD curriculum training deserves being improved. Conclusion: Despite guideline recommendations, GH replacement in AGHD is still not available or reimbursed in all European countries. Knowledge among professionals and health administrators needs improvement to optimise the care of adults with GHD.
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Submitted on : Friday, July 30, 2021 - 4:24:41 PM
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Luciana Martel-Duguech, Jens Otto L Jorgensen, Márta Korbonits, Gudmundur Johannsson, Susan Webb, et al.. ESE audit on management of adult growth hormone deficiency in clinical practice. European Journal of Endocrinology, BioScientifica, 2021, 184 (2), pp.323 - 334. ⟨10.1530/eje-20-1180⟩. ⟨hal-03310785⟩

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