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Growth hormone deficient patients...

From Endocrine Abstracts

Growth hormone deficient patients over 60 years require a low dose of GH and short titration phase to achieve normal serum IGF-I levels

PM Mah1, J Newell-Price1, A Doane1, V Ibbotson1, K Ho2 & RJ Ross1

1Division of Clinical Sciences, Northern General Hospital, Sheffield, United Kingdom; 2The Garvan Institute, Sydney, Australia.

AIM: 1) To determine GH dose requirement in GH deficient patients aged over 60 years.

METHODS: The study was approved by the local Ethics Committee. Patients were started on Genotropin 0.4 units (0.13 mg)/day after baseline assessment. Serum IGF-I was repeated at 2-weekly intervals. Maintenance GH dose was achieved when serum IGF-1 was between the median and upper end of the age-related range.

RESULTS: 16 patients (10 men & 6 women) were recruited. Their median (range) age is 70 (63-77) years, height is 1.69 (1.55-1.87) m, weight is 79.9 (60.4-97.6) kg and body mass index is 27.5 (23.0-35.5) kg/m2. They are on at least one other pituitary hormone replacement therapy and had either pituitary surgery/radiotherapy or diagnosis for a median of 5.5 (1.0-41.0) years. Median baseline serum IGF-1 is 67 (22-263) ng/mL, percentage body fat is 30.5 (15-53)%, ratio of total cholesterol/HDL is 4.3 (2.7-8.0), and AGHDA score is 11 (0-21). All 16 patients have achieved maintenance GH dose. Six patients are on 0.4 units (0.13 mg), 7 on 0.8 units (0.27 mg), 1 patient each on 1.2 units (0.40 mg), 1.6 units (0.53 mg) and 2.4 units (0.80 mg) of GH daily. The patient on 2.4 units is a woman on oral oestrogen-containing HRT. There was a trend towards patients receiving higher doses of GH if they had lower baseline serum IGF-1 (r=0.42, p=0.10). The median time taken for titration to reach maintenance dose was 5.9 (2.3-18.7) weeks.

CONCLUSIONS: Older GH deficient patients require a lower dose of GH compared to younger patients, and a short titration phase.