CHARACTERISTICS OF ADULTS WHO WISH TO ENTER A TRIAL OF GROWTH-HORMONEREPLACEMENT

OBJECTIVE It is possible that the degree of perceived well-being may I nfluence the decision of an adult with GH deficiency to receive GH rep lacement. We have therefore sought factors which influenced whether or not such a patient wished to enter a study of GH replacement. DESIGN Biochemical, anthropometric and demographic characteristics, and well- being, of patients who chose to enter a 12-month study of GH replaceme nt at Christie Hospital NHS Trust were compared with those of patients who declined to enter the study. PATIENTS Sixty-five adults with GH d eficiency who entered a study of GH replacement and 33 adults with GH deficiency who were approached but who declined to enter the study. ME ASUREMENTS The two groups of patients were compared according to sex, age, height, weight, body mass index, peak serum GH response to provoc ative testing, estimated duration of GH deficiency, whether GH deficie ncy was of childhood or adult onset, presence or absence of additional pituitary hormone deficiencies, aetiology of GH deficiency, previous therapeutic interventions, employment status, marital status and livin g arrangement (65 entered vs 33 declined to enter). Well-being or dist ress was measured using the Nottingham Health Profile (NHP) (65 entere d vs 20 declined to enter) and the Psychological General Well-being Sc hedule (PGWBS) (33 entered vs 19 declined to enter). RESULTS Those who entered the study had significantly higher scores on the energy (P=0. 03) and emotional reaction (P=0.02) subsections and on the total score (P=0.04) of the NHP, indicating greater distress, and had a significa ntly lower score (P=0.009) on the vitality subsection of the PGWBS, ag ain indicating greater distress. Those who entered the study had a sig nificantly lower prevalence of non-functioning pituitary adenoma (P = 0.02) but there was no other difference in biochemical, anthropometric or demographic characteristics between the two groups. CONCLUSION Adu lts who enter a study of GH replacement exhibit greater distress on qu estionnaire assessment than those who decline to enter such a study. T his bias must be considered when interpreting studies of the effect of GH replacement on well-being in adults.