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 M 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) , Frédérique Albarel (9, 11) , S Cannavo (12) , G Martino (12) , O R 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 I 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 L Monzani (29) , K Sandahl (30) , S Tsagarakis (31) , V Mitravela (31) , S Zacharieva (32) , B Zilatiene (33) , R Verkauskiene (33)

1 UAB - Universitat Autònoma de Barcelona = Autonomous University of Barcelona = Universidad Autónoma de Barcelona
2 Starling House
3 QMUL - Queen Mary University of London
4 GU - Göteborgs Universitet = University of Gothenburg
5 General Hospital of Thessaloniki "Ippokrateio"
6 UNIMI - Università degli Studi di Milano = University of Milan
7 Diabetes Endocrinology and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases
8 UniGe - Università degli studi di Genova = University of Genoa
9 MMG - Marseille medical genetics - Centre de génétique médicale de Marseille
10 MarMaRa - Institut Marseille Maladies Rares
11 Service d'endocrinologie, diabète, maladies métaboliques [Hôpital de la Conception - APHM]
12 University of Messina
13 Universidade do Porto = University of Porto
14 CHU Basel
15 Sheffield Teaching Hospitals
16 University Hospital Center Zagreb
17 Hospital General Universitario "Gregorio Marañón" [Madrid]
18 UNITO - Università degli studi di Torino = University of Turin
19 Hungarian Defense Forces
20 Karolinska University Hospital [Stockholm]
21 UMCL - University Medical Centre Ljubljana [Ljubljana, Slovenia]
22 Comenius University in Bratislava
23 University Hospital Center Split
24 University of Belgrade [Belgrade]
25 ULL - Universidad de La Laguna [Tenerife - SP]
26 University Miguel Hernández
27 Macquarie University
28 Hôpital Louis Pradel [CHU - HCL]
29 UNIMORE - Università degli Studi di Modena e Reggio Emilia = University of Modena and Reggio Emilia
30 Aarhus University Hospital
31 Evangelismos Athens General Hospital
32 Medical University of Sofia [Bulgarie]
33 LSMU - Lithuanian University of health Sciences

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.

Domaines: Médecine humaine et pathologie

Luciana Martel-Duguech, Jens Otto L Jorgensen, Márta Korbonits, Gudmundur Johannsson, Susan M Webb, et al.. ESE audit on management of adult growth hormone deficiency in clinical practice. European Journal of Endocrinology, 2021, 184 (2), pp.323 - 334. ⟨10.1530/eje-20-1180⟩. ⟨hal-03310785⟩