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Dehydroepiandrosterone sulphate levels inpatients with hypopituitarism and severe growth hormone (GH) deficiency: Comparison with insulin-like growth factor I levels before and during GH replacement
Poster abstracts 141
approximate prevalence of 47.2 and 46.5 per 100,000 for men and women, respectively. The prevalence of GHD was 25.4 per 100,000 in patients aged 15-24 years and 91.4 per 100,000 in patients aged over 85 years. Patients with GHD were responsible for a total of 280 in-patient admissions during the period 1995-1997, a 4.6-fold increase for men and a 2.8-fold increase for women, compared with the general population. Patients with hypopituitarism and GHD had an average length of hospital stay of 8.3 days compared with 4.5 days for the general population. Of the 162 adults with hypopituitarism and GHD, 16 had a psychiatric condition; this represents a relative risk of 2.17 (95% confidence interval, 1.37-3.46; P < 0.005). Mean length of stay per psychiatric admission was lower for patients with GHD compared with patients without GHD (21.0 days and 46.6 days,
respectively; P = 0.05). During the period 1991-1997, mean total length of hospital stay per psychiatric patient was 61.0 days for patients with GHD (an average of 3.0 admissions per patient) compared with 75.5 days for the psychiatric population as a whole (an average of 1.6 admissions per patient). In conclusion, this study confirms a higher prevalence of psychiatric illness amongst patients with hypopituitarism and GHD than the general population. Analysis of in-patient care may indicate that psychiatric illness manifests itself in relatively acute episodes rather than demanding long-stay care. Furthermore, the utilization of in-patient services is higher than expected in patients with hypopituitarism and GHD; this will have cost implications and so should be considered in any economic evaluation of treatment for GHD.
Dehydroepiandrosterone sulphate levels in patients with hypopituitarism and severe growth hormone (GH) deficiency: comparison with insulin-like growth factor I levels before and during GH replacement G. Aimaretti, ~ C. Baffoni, 1 M. R. Ambrosio, 2 M. Maccario] G. CornelU S. Bellone, 1 M. Gasperi, 3 E. Degli Uberti 2 and E. Ghigo ~ ~Division of Endocrinology, Department of Medicine, University of Turin, Italy, 2Division of Endocrinology, University of Ferrara and 3Division of Endocrinology, University of Pisa, Italy
Levels of insulin-like growth factor I (IGF-I) and dehydroepiandrosterone sulphate (DHEA-S) decrease with age, probably because of changes in body composition, structure, function and metabolism. Mean IGF-I levels are reduced in patients with hypopituitarism and growth hormone deficiency (GHD); however, there are few data about DHEA-S levels in patients with hypopituitarism. The aim of this study was to evaluate levels of DHEA-S and IGF-I in patients with panhypopituitarism and GHD before and after 3 months of GH replacement therapy. A total of 90 patients were included in the analysis before GH therapy (49 women, 41 men; age range, 20-80 years; body mass index, 26.4 _+ 0.6 kg/m2): 21 patients had childhood-onset hypopituitarism and 69 had adult-onset hypopituitarism. A total of 24 patients with hypopituitarism and GHD were evaluated after 3 months of GH replacement therapy. Data from patients with hypopituitarism were compared with those from healthy controls (233 women, 103 men; age range, 20-80 years). In controls, both DHEA-S and IGF-I levels were independent of gender and correlated inversely with age (r = -0.6, P< 0.001 and r= -0.56, P< 0.0001, respectively), but no relationship was found between these variables. In patients with hypopituitarism, age-adjusted mean DHEA-S and IGF-I levels were clearly lower than controls (23.4 _+ 3.3 vs 160.0 _+ 4.8 lag/dl, P < 0.005; 71.1 + 4.5 vs 170.0 + 4.7 lag/l, P < 0.005, respectively). IGF-I levels in patients with childhood-onset hypopituitarism were lower than in patients with adult-onset hypopituitarism
(49.6 + 4.8 vs 77.0 -+ 5.4 tag/l, P< 0.01), wherease DHEA-S levels were similar in both subgroups (26.0 _+6.7 vs 22.3 _+3.7 lag/dl). In patients with hypopituitarism, levels of both DHEA-S and IGF-I were independent of age and gender, with a trend toward a positive correlation between each other (r = 0.45; P < 0.003). On analysing levels of IGF-I in individual patients with hypopituitarism with respect to age-adjusted normal ranges, it was found that IGF-I levels were below normal in 84, 62 and 0% of patients who were 20-40, 40-60 and 60-80 years of age, respectively. In contrast, DHEA-S levels were below normal in 84, 86 and 67% of patients who were 20-40, 40-60 and 60-80 years of age, respectively. In patients with hypopituitarism, GH treatment for 3 months significantly increased IGF-I levels (150.0 _+ 3.2 vs 85.3 _+4.1 lag/l, P < 0.005), but did not modify DHEA-S levels (17.2 + 2.5 vs 15.8 _+ 2.5 lag/dl). In conclusion, this study demonstrates that DHEA-S and IGF-I are negatively and independently associated with age in physiological conditions but not in patients with hypopituitarism, in whom both are strikingly reduced. Both DHEA-S and IGF-I levels in patients with hypopituitarism show some overlap with those in normal individuals; thus the measurement of these parameters is not diagnostic for hypopituitarism. Evidence that GH replacement therapy restores IGF-I levels but does not modify DHEA-S levels indicates that DHEA-S reduction in patients with hypopituitarism is not dependent on IGF-I.
approximate prevalence of 47.2 and 46.5 per 100,000 for men and women, respectively. The prevalence of GHD was 25.4 per 100,000 in patients aged 15-24 years and 91.4 per 100,000 in patients aged over 85 years. Patients with GHD were responsible for a total of 280 in-patient admissions during the period 1995-1997, a 4.6-fold increase for men and a 2.8-fold increase for women, compared with the general population. Patients with hypopituitarism and GHD had an average length of hospital stay of 8.3 days compared with 4.5 days for the general population. Of the 162 adults with hypopituitarism and GHD, 16 had a psychiatric condition; this represents a relative risk of 2.17 (95% confidence interval, 1.37-3.46; P < 0.005). Mean length of stay per psychiatric admission was lower for patients with GHD compared with patients without GHD (21.0 days and 46.6 days,
respectively; P = 0.05). During the period 1991-1997, mean total length of hospital stay per psychiatric patient was 61.0 days for patients with GHD (an average of 3.0 admissions per patient) compared with 75.5 days for the psychiatric population as a whole (an average of 1.6 admissions per patient). In conclusion, this study confirms a higher prevalence of psychiatric illness amongst patients with hypopituitarism and GHD than the general population. Analysis of in-patient care may indicate that psychiatric illness manifests itself in relatively acute episodes rather than demanding long-stay care. Furthermore, the utilization of in-patient services is higher than expected in patients with hypopituitarism and GHD; this will have cost implications and so should be considered in any economic evaluation of treatment for GHD.
Dehydroepiandrosterone sulphate levels in patients with hypopituitarism and severe growth hormone (GH) deficiency: comparison with insulin-like growth factor I levels before and during GH replacement G. Aimaretti, ~ C. Baffoni, 1 M. R. Ambrosio, 2 M. Maccario] G. CornelU S. Bellone, 1 M. Gasperi, 3 E. Degli Uberti 2 and E. Ghigo ~ ~Division of Endocrinology, Department of Medicine, University of Turin, Italy, 2Division of Endocrinology, University of Ferrara and 3Division of Endocrinology, University of Pisa, Italy
Levels of insulin-like growth factor I (IGF-I) and dehydroepiandrosterone sulphate (DHEA-S) decrease with age, probably because of changes in body composition, structure, function and metabolism. Mean IGF-I levels are reduced in patients with hypopituitarism and growth hormone deficiency (GHD); however, there are few data about DHEA-S levels in patients with hypopituitarism. The aim of this study was to evaluate levels of DHEA-S and IGF-I in patients with panhypopituitarism and GHD before and after 3 months of GH replacement therapy. A total of 90 patients were included in the analysis before GH therapy (49 women, 41 men; age range, 20-80 years; body mass index, 26.4 _+ 0.6 kg/m2): 21 patients had childhood-onset hypopituitarism and 69 had adult-onset hypopituitarism. A total of 24 patients with hypopituitarism and GHD were evaluated after 3 months of GH replacement therapy. Data from patients with hypopituitarism were compared with those from healthy controls (233 women, 103 men; age range, 20-80 years). In controls, both DHEA-S and IGF-I levels were independent of gender and correlated inversely with age (r = -0.6, P< 0.001 and r= -0.56, P< 0.0001, respectively), but no relationship was found between these variables. In patients with hypopituitarism, age-adjusted mean DHEA-S and IGF-I levels were clearly lower than controls (23.4 _+ 3.3 vs 160.0 _+ 4.8 lag/dl, P < 0.005; 71.1 + 4.5 vs 170.0 + 4.7 lag/l, P < 0.005, respectively). IGF-I levels in patients with childhood-onset hypopituitarism were lower than in patients with adult-onset hypopituitarism
(49.6 + 4.8 vs 77.0 -+ 5.4 tag/l, P< 0.01), wherease DHEA-S levels were similar in both subgroups (26.0 _+6.7 vs 22.3 _+3.7 lag/dl). In patients with hypopituitarism, levels of both DHEA-S and IGF-I were independent of age and gender, with a trend toward a positive correlation between each other (r = 0.45; P < 0.003). On analysing levels of IGF-I in individual patients with hypopituitarism with respect to age-adjusted normal ranges, it was found that IGF-I levels were below normal in 84, 62 and 0% of patients who were 20-40, 40-60 and 60-80 years of age, respectively. In contrast, DHEA-S levels were below normal in 84, 86 and 67% of patients who were 20-40, 40-60 and 60-80 years of age, respectively. In patients with hypopituitarism, GH treatment for 3 months significantly increased IGF-I levels (150.0 _+ 3.2 vs 85.3 _+4.1 lag/l, P < 0.005), but did not modify DHEA-S levels (17.2 + 2.5 vs 15.8 _+ 2.5 lag/dl). In conclusion, this study demonstrates that DHEA-S and IGF-I are negatively and independently associated with age in physiological conditions but not in patients with hypopituitarism, in whom both are strikingly reduced. Both DHEA-S and IGF-I levels in patients with hypopituitarism show some overlap with those in normal individuals; thus the measurement of these parameters is not diagnostic for hypopituitarism. Evidence that GH replacement therapy restores IGF-I levels but does not modify DHEA-S levels indicates that DHEA-S reduction in patients with hypopituitarism is not dependent on IGF-I.