Effect van groeihormoonbehandeling op sterfte bij volwassenen met ernstige groeihormoondeficiëntie*

Objective

Investigation of the long-term effect of growth hormone treatment on the a priori increased risk of mortality in adults with severe growth hormone deficiency, and in particular mortality as a consequence of cardiovascular disease and malignancy.

Design

Nationwide cohort study

Methods

Follow-up data was collected for the period 1985-2009 concerning 2694 patients with severe growth hormone deficiency in the Dutch National Registry of Growth Hormone Treatment in Adults. The standardised mortality ratio (SMR) was calculated for 2229 patients who were treated with growth hormone from the beginning to the end of the follow-up period. The SMR was also calculated for disease-specific mortality and corrected for various patient characteristics.

Results

In total 95 patients died whereas the expected number was 74.6 (SMR 1.27; 95% confidence interval 1.04–1.56). The mortality in women was significantly higher than in men. After exclusion of high-risk patients, there was no difference in mortality between the treated men and the general population. Mortality due to cardiovascular disease remained elevated in the treated women. Mortality due to malignancy was not elevated. Sex, age, cranial radiotherapy and underlying complaints were relevant patient characteristics.

Conclusions

Men with growth hormone deficiency who received long-term treatment with growth hormone had a mortality comparable with the general Dutch population. In women with growth hormone deficiency, the mortality remained elevated as a result of a higher occurrence of cardiovascular disease. Treatment with growth hormone did not lead to increased mortality due to malignancy. We conclude that the sex and the heterogeneous nature of the group of patients with growth hormone deficiency are important for the assessment of the effect of growth hormone on mortality

Conflict of interest: A.A.M. Franken received reimbursement for his activities for the Medicines Evaluation Board (CBG-MEB). The foundation of the Dutch National Registry of Growth Hormone Treatment in Adults was financed by the Health Care Insurance Board. Financial support for this article: none declared.