Baseline clinical factors associated with cessation of growth hormone therapy in patients with severe growth hormone deficiency-real world evidence

Nadarajah, Nageswary; Ssemmondo, Emmanuel; Brooks, Shani; Akinyombo, Remi; Adeleke, Kazeem; Deshmukh, Harshal; Sathyapalan, Thozhukat

Abstract

Background: Growth hormone replacement is indicated in adults with severe growth hormone (GH) deficiency, adult growth
hormone deficiency assessment (AGHDA) score of at least 11 and are receiving treatment for other pituitary hormone
deficiencies. There are no data looking at the cessation of GH replacement in adult patients with severe GH deficiency and the
factors that predict the likelihood of patients continuing or stopping growth hormone replacement.
Methods: We audited patients on the GH register between January 2006 and January 2023 in Hull University Teaching
Hospitals NHS foundation Trust, a UK tertiary hospital. Baseline characteristics, the cause of GH deficiency, AGHDA score at
diagnosis and the reason for stopping GH were collected. Proportions were compared between patients adhering to GH
replacement and those who had ceased it. Logistic regression analysis was used to identify factors independently associated
with cessation of GH.
Results: The study comprised 141 adult patients with a mean age of 52 years, of which 75 (53%) were female. 54 (38%) individuals
had discontinued GH replacement therapy. Predominant reasons for discontinuation were lack of therapeutic benefit (46%) and
a change in clinical indication (26%). Among patients who discontinued GH therapy, the most frequent cause of GH deficiency
was idiopathic (57%), while for those on GH replacement, pituitary surgery was the leading cause of GH deficiency (53%). Logistic
regression analysis showed no baseline factor was statistically significantly associated with GH cessation, except female gender
which had a borderline significance (P = 0.05).
Conclusions: In this real-world investigation of patients with severe GH deficiency, over two in five individuals who
discontinued GH therapy cited the absence of perceived benefits. We show a borderline association of female gender with GH
cessation and large population-based studies will be needed to investigate this and other causes of GH cessation.

• Journal Article Type: Article
• Acceptance Date: Sep 17, 2024
• Online Publication Date: Oct 27, 2024
• Publication Date: 2024
• Deposit Date: Apr 7, 2025
• Publicly Available Date: Apr 8, 2025
• Journal: Int J Endocrinol Metab
• Print ISSN: 1726-913X
• Electronic ISSN: 1726-9148
• Publisher: Brieflands
• Peer Reviewed: Peer Reviewed
• Volume: 22
• Issue: 3
• Article Number: e147825
• DOI: https://doi.org/10.5812/ijem-147825
• Keywords: Growth Hormone, Clinical Factors, Therapy Cessation
• Public URL: https://uwe-repository.worktribe.com/output/14282232