QUALITY-OF-LIFE, BODY-COMPOSITION AND MUSCLE STRENGTH IN ADULT GROWTH-HORMONE DEFICIENCY - THE INFLUENCE OF GROWTH-HORMONE REPLACEMENT THERAPY FOR UP TO 3 YEARS

OBJECTIVE Adults with GH deficiency complain frequently of low energy levels, emotional lability and mental fatigue resulting in a low perce ived quality of life (QOL). Body composition is altered with increased fat mass and decreased lean body mass and muscle strength is reduced. The aims of this study were to determine the effects of replacement G H treatment on: (a) body composition and muscle strength and (b) QOL, using specifically selected and adapted measures. DESIGN A 12-month st udy (double-blind placebo-controlled for the first 6 months and open f or the second 6 months) of GH replacement injections (0.125 iu/kg/week for the first month and 0.25 iu/kg/week for the following 5 months of each study period) in GH deficient adults on QOL, body composition an d muscle strength. This was followed by an open study of a further 12 months' GH treatment assessing QOL and muscle strength. Finally, QOL w as assessed after up to 3 years of GH replacement treatment. PATIENTS Thirty of the 32 adult patients with GH deficiency enrolled completed the initial 12-month study (10 male, mean age 33 5 years, mean (SD) st imulated serum GH response 3.0 mU/I (2.86)). Nineteen patients then op ted to continue GH treatment. Of these, 13 patients were available for assessment after a further 12 months' and 24 months' treatment. MEASU REMENTS Health-related QOL was assessed using 2 specifically adapted s cales for adults with GH deficiency: the Life Fulfilment Scale and the Impact Scale. In addition 4 other self-rating questionnaires were use d: Nottingham Health Profile, Hospital Anxiety and Depression Scale, S elf Esteem Scale and Mental Fatigue Scale. Body composition was assess ed by DEXA and quadriceps muscle strength by measuring maximum volunta ry contractions. RESULTS In the initial 12 months' placebo-controlled study perceived energy levels increased after 6 and 12 months of GH tr eatment (P<0.01 compared with baseline) in the patients receiving GH f or the full 12-month period. There were no changes in energy levels th roughout the study in the group receiving placebo for the first 6 mont hs. Also small improvements in impact scores were found after 6 months of GH treatment (P<0.05) but this was not sustained at 12 months. In both GH and placebo groups life fulfilment worsened after 6 months, bu t then improved to baseline values after 12 months. In the patients wh o persisted with GH replacement, energy levels continued to improve (a t 2 years, P<0.01 compared with baseline) but then fell (at 3 years, P =NS compared with baseline). A similar pattern was observed in emotion al reaction scores. However, improvements in self-esteem were maintain ed (at 3 years, P<0.05 compared with baseline). Body composition alter ed favourably over the initial 12-month study period with a significan t increase in lean mass and decrease in fat mass in both groups after 6-12 months of GH. There were no changes in muscle strength in either group during the initial 12-month study. However, in the patients who were available for assessment after a further 12 months of GH treatmen t, muscle strength increased significantly (P<0.02 compared with basel ine). CONCLUSION GH replacement treatment for 6-12 months leads to sig nificant improvements in body composition (DEXA) but longer-term treat ment may be needed to increase muscle strength. Self-esteem scores imp rove and are maintained after 3 years of treatment. Energy levels and emotional reaction improve during treatment for up to 2 years but decl ine thereafter.