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Published in: Pituitary 6/2018

01-12-2018

Decreased quality of life (QoL) in hypopituitary patients: involvement of glucocorticoid replacement and radiation therapy

Authors: Adnan Ajmal, Erin McKean, Stephen Sullivan, Ariel Barkan

Published in: Pituitary | Issue 6/2018

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Abstract

Purpose

Hypopituitary patients are assumed to have decreased QoL due to GHD. However, in placebo controlled trials, the effects of GH replacement are no different from placebo. Hydrocortisone dose > 20 mg/day and pituitary radiation are independently associated with poorer QoL. We assessed QoL in panhypopituitary GH- deficient patients never treated with GH.

Methods

Study group was divided into: (a) surgery followed by radiation (n = 21) and (b) surgery alone (n = 32). Mean duration of GHD was 71.4 ± 7.8 months and mean daily hydrocortisone dose was 15 ± 0.7 mg. Control group had transnasal surgery for benign sinus conditions (n = 54).

Results

AGHDA scores were significantly worse in the entire study group compared to controls (8.1 ± 1.0 vs. 5.1 ± 0.9, p = 0.03). In patients with history of radiation therapy AGHDA scores were significantly worse than in controls (9.1 ± 1.5, p = 0.02) and SNOT-22 (Sino-Nasal Outcome Test) scores were also significantly worse (15.8 ± 2.0 vs. 23.2 ± 3.5, p = 0.04). However, AGHDA scores in patients without history of radiation and on “physiological” dose of hydrocortisone were similar to those in controls (5.1 ± 0.9 vs. 7.3 ± 1.3, p = 0.17).

Conclusions

Replacement with hydrocortisone doses not exceeding 20 mg/day and avoidance of radiation therapy was accompanied by normal QoL in patients not replaced with GH. Thus, we suggest that the decreased QoL in hypopituitary patients may not be due to GH deficiency per se, but rather to high hydrocortisone doses and to aftereffects of cranial radiation.
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Metadata
Title
Decreased quality of life (QoL) in hypopituitary patients: involvement of glucocorticoid replacement and radiation therapy
Authors
Adnan Ajmal
Erin McKean
Stephen Sullivan
Ariel Barkan
Publication date
01-12-2018
Publisher
Springer US
Published in
Pituitary / Issue 6/2018
Print ISSN: 1386-341X
Electronic ISSN: 1573-7403
DOI
https://doi.org/10.1007/s11102-018-0918-y

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