{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2023,10,17]],"date-time":"2023-10-17T18:39:41Z","timestamp":1697567981355},"reference-count":41,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2001,12,24]],"date-time":"2001-12-24T00:00:00Z","timestamp":1009152000000},"content-version":"vor","delay-in-days":663,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2000,3]]},"abstract":"<jats:sec><jats:title>OBJECTIVES<\/jats:title><jats:p>Adult GH deficiency (GHD) is associated with profound alterations in body composition, lipid profiles and quality of life which frequently improve after GH therapy. However, the beneficial effects of treatment are not derived by all and consequently some scepticism persists with regard to the use of GH therapy in adults. We assessed whether a 3\u2010month therapeutic assessment with GH therapy could be used to determine which GHD adults should be treated over the longer term. We also assessed the continued prescription of GH by general practitioners (GPs) following the initial therapeutic assessment.<\/jats:p><\/jats:sec><jats:sec><jats:title>DESIGN<\/jats:title><jats:p>A three month open therapeutic trial of GH in GHD adults. Patients were treated with GH at an initial dose of 0.01 iU\/kg\/d, increased after 1 month to 0.015 iU\/kg\/d for males and 0.02 iU\/kg\/d for females. After completion of the three months the continued prescription of GH by the GPs was assessed.<\/jats:p><\/jats:sec><jats:sec><jats:title>PATIENTS<\/jats:title><jats:p>All adult GHD patients were considered for GH therapy. Thirty\u2010nine GHD adults wanted GH therapy (group 1) and their baseline characteristics such as age, duration of GHD, and IGF\u20101 concentration were compared with 24 subjects who declined to receive GH (group 2).<\/jats:p><\/jats:sec><jats:sec><jats:title>MEASUREMENTS<\/jats:title><jats:p>Measurements of body composition using bioelectrical impedance analysis, lipids and quality of life measured using a dedicated questionnaire were made before and after GH therapy. The response of the general practitioners to continued GH therapy after the initial therapeutic assessment was also noted.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Compared with subjects who declined GH therapy (group 2), subjects of group 1 were younger (46.4\u2003\u00b1\u200314.4 <jats:italic>vs<\/jats:italic>. 54.2\u2003\u00b1\u200315.7 years, <jats:italic>P<\/jats:italic>\u2003&lt;\u20030.05) and had lower peak GH responses to provocative testing (1.4\u2003\u00b1\u20032.1 <jats:italic>vs<\/jats:italic>. 2.9\u2003\u00b1\u20032.7\u2003mU\/l, <jats:italic>P<\/jats:italic>\u2003&lt;\u20030.001), though there were no differences between IGF\u20101 concentration (11.7\u2003\u00b1\u20036.2 <jats:italic>vs<\/jats:italic>. 14.2\u2003\u00b1\u20037.9\u2003nmol\/l). Following three months of GH therapy, there were significant improvements in all measured parameters including increased free fat mass (50.2 <jats:italic>vs<\/jats:italic>. 52.4\u2003kg, <jats:italic>P<\/jats:italic>\u2003&lt;\u20030.005) and total body water (37 <jats:italic>vs<\/jats:italic>. 38.7\u2003l, <jats:italic>P<\/jats:italic>\u2003&lt;\u20030.005), reduced fat mass (31.6 <jats:italic>vs<\/jats:italic>. 29.8\u2003kg, <jats:italic>P<\/jats:italic>\u2003&lt;\u20030.005), reduced AGHDA score (7 <jats:italic>vs<\/jats:italic>. 4, <jats:italic>P<\/jats:italic>\u2003&lt;\u20030.001) and reduced cholesterol (6.3 <jats:italic>vs<\/jats:italic>. 5.8\u2003mmol\/l, <jats:italic>P<\/jats:italic>\u2003&lt;\u20030.001), LDL (4 <jats:italic>vs<\/jats:italic>. 3.33\u2003mmol\/l, <jats:italic>P<\/jats:italic>\u2003&lt;\u20030.001) and cholesterol\/HDL ratio (5.57 <jats:italic>vs<\/jats:italic>. 4.67, <jats:italic>P<\/jats:italic>\u2003&lt;\u20030.001). IGF\u20101 concentrations were significantly increased following treatment (12 <jats:italic>vs<\/jats:italic>. 32.4\u2003nmol\/l). Six subjects decided to discontinue GH therapy, 2 before the end of the study due to potential drug\u2010related side\u2010effects and 4 subjects derived no benefit from treatment. Despite the demonstrable benefits of treatment for the remaining 33 GHD adults, 6 GPs refused to continue to prescribe GH therapy for reasons of lack of familiarity with the drug or advice from their health authority.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSION<\/jats:title><jats:p>Patients who wanted GH therapy were usually younger and more severely GHD than counterparts who elect not to be treated. However, a therapeutic trial of GH therapy is required to distinguish those subjects who derive benefit from treatment. We have shown that three months of low dose GH therapy is a sufficient period to elicit significant beneficial responses in quality of life, body composition parameters and lipids for the majority of patients and appears to be a sufficient period for patients to decide whether they want longer term therapy. The initial therapeutic trial also provides the objective evidence for the general practitioners to decide upon the continued prescription of therapy. Despite the positive evidence provided by this study, a small minority of general practitioners still refuse to prescribe GH therapy.<\/jats:p><\/jats:sec>","DOI":"10.1046\/j.1365-2265.2000.00964.x","type":"journal-article","created":{"date-parts":[[2003,3,11]],"date-time":"2003-03-11T10:44:27Z","timestamp":1047379467000},"page":"295-303","source":"Crossref","is-referenced-by-count":5,"title":["A therapeutic trial of growth hormone in hypopituitary adults and its influence upon continued prescription by general practitioners"],"prefix":"10.1111","volume":"52","author":[{"family":"Davies","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"family":"Obuobie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"family":"Smith","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"family":"Rees","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"family":"Furlong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"family":"Davies","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"family":"Evans","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"family":"Scanlon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2001,12,24]]},"reference":[{"key":"e_1_2_5_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/clinchem\/20.4.470"},{"key":"e_1_2_5_3_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.82.1.82"},{"key":"e_1_2_5_4_2","first-page":"620","article-title":"Comparison of acid ethanol extraction and acid gel filtration prior to IGF\u20101 and IGF\u2010II radioimmunoassays: improvement of determinations in acid ethanol extracts by the use of truncated IGF\u2010I as radioligand","volume":"124","author":"Bang P.","year":"1991","journal-title":"Acta Endocrinologica"},{"key":"e_1_2_5_5_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.76.2.309"},{"key":"e_1_2_5_6_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.1995.tb02601.x"},{"key":"e_1_2_5_7_2","doi-asserted-by":"crossref","first-page":"918","DOI":"10.1093\/ajcn\/55.5.918","article-title":"Body composition in growth hormone deficient adults","volume":"55","author":"Binnerts A.","year":"1992","journal-title":"American Journal of Clinical Nutrition"},{"key":"e_1_2_5_8_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.1992.tb02287.x"},{"key":"e_1_2_5_9_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.81.5.1704"},{"key":"e_1_2_5_10_2","first-page":"127","article-title":"Comparison of body composition determinations using bioelectrical impedance analysis in growth hormone deficiency","volume":"2","author":"Brummer R.J.M.","year":"1995","journal-title":"Endocrinology and Metabolism"},{"key":"e_1_2_5_11_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2265.1997.d01-1749.x"},{"key":"e_1_2_5_12_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2265.1999.00595.x"},{"key":"e_1_2_5_13_2","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1991.70.2.688"},{"key":"e_1_2_5_14_2","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1152\/jappl.1991.70.2.695","article-title":"Growth hormone treatment in growth hormone deficient adults. II Effects on exercise performance","volume":"70","author":"Cuneo R.C.","year":"1991","journal-title":"Journal of Applied Physiology"},{"key":"e_1_2_5_15_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.1992.tb02347.x"},{"key":"e_1_2_5_16_2","doi-asserted-by":"publisher","DOI":"10.1210\/er.16.1.63"},{"key":"e_1_2_5_17_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.80.7.2069"},{"key":"e_1_2_5_18_2","doi-asserted-by":"publisher","DOI":"10.1159\/000191325"},{"key":"e_1_2_5_19_2","doi-asserted-by":"crossref","first-page":"3913","DOI":"10.1210\/jcem.83.11.5223","article-title":"Optimising GH replacement therapy by dose titration in hypopituitary adults","volume":"83","author":"Drake W.M.","year":"1998","journal-title":"Journal of Clinical Endocrinology and Metabolism"},{"key":"e_1_2_5_20_2","first-page":"220","article-title":"Growth Hormone replacement therapy reverses endothelial dysfunction in hypopituitary adults with growth hormone deficiency","volume":"1","author":"Evans L.M.","year":"1998","journal-title":"80th Meeting of the American Endocrine Society, Abstract"},{"key":"e_1_2_5_21_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2265.1996.830895.x"},{"key":"e_1_2_5_22_2","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1093\/clinchem\/18.6.499","article-title":"Estimation of the concentration of LDL cholesterol in plasma without use of the preparative ultracentrifuge","volume":"18","author":"Friedewald W.T.","year":"1972","journal-title":"Clinical Chemistry"},{"key":"e_1_2_5_23_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.83.2.379"},{"key":"e_1_2_5_24_2","first-page":"63","article-title":"Development of a questionnaire to assess the quality of life of adults with growth hormone deficiency","volume":"2","author":"Holmes S.J.","year":"1995","journal-title":"Endocrinology and Metabolism"},{"key":"e_1_2_5_25_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.1995.tb01909.x"},{"key":"e_1_2_5_26_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.1995.tb02688.x"},{"key":"e_1_2_5_27_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.82.10.3285"},{"key":"e_1_2_5_28_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.81.4.1575"},{"key":"e_1_2_5_29_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2265.1997.3271123.x"},{"key":"e_1_2_5_30_2","first-page":"641","article-title":"Cholesterol and coronary heart disease: Predicting risks by levels and ratios","volume":"121","author":"Kinosian B.","year":"1994","journal-title":"Archives of Internal Medicine"},{"key":"e_1_2_5_31_2","first-page":"43","article-title":"GH replacement therapy in adult hypopituitary patients with GHD: combined data from 12 European placebo controlled clinical trials","volume":"1","author":"Mardh G.","year":"1994","journal-title":"Endocrinology and Metabolism"},{"key":"e_1_2_5_32_2","first-page":"11","article-title":"GH replacement therapy in adult hypopituitary patients with GHD: combined clinical safety data from clinical trials in 665 patients","volume":"2","author":"Mardh G.","year":"1995","journal-title":"Endocrinology and Metabolism"},{"key":"e_1_2_5_33_2","doi-asserted-by":"publisher","DOI":"10.1159\/000181584"},{"key":"e_1_2_5_34_2","doi-asserted-by":"publisher","DOI":"10.1097\/00041433-199906000-00004"},{"key":"e_1_2_5_35_2","doi-asserted-by":"publisher","DOI":"10.1016\/0140-6736(90)91812-O"},{"key":"e_1_2_5_36_2","doi-asserted-by":"publisher","DOI":"10.1530\/acta.0.1290195"},{"key":"e_1_2_5_37_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198912283212605"},{"key":"e_1_2_5_38_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.314.7080.600"},{"key":"e_1_2_5_39_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.1993.tb02387.x"},{"key":"e_1_2_5_40_2","doi-asserted-by":"crossref","unstructured":"Wahlefeld A.W.(1974) Triglycerides. Determination after enzymatic hydrolysis. In:Methods of Enzymatic Analysis. (ed. H.U. Bergmeyer) pp.18311835. Verlag Chemie Weinheim\/Academic Press Inc New York.","DOI":"10.1016\/B978-0-12-091304-6.50036-7"},{"key":"e_1_2_5_41_2","first-page":"167","article-title":"Quality of life of adult patients with GH deficiency in Sweden compared with a random population sample assessed by QoL\u2010AGHDA","volume":"4","author":"Wiren L.","year":"1997","journal-title":"Endocrinology and Metabolism"},{"key":"e_1_2_5_42_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2265.1998.00462.x"}],"container-title":["Clinical Endocrinology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1046%2Fj.1365-2265.2000.00964.x","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1046\/j.1365-2265.2000.00964.x","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,15]],"date-time":"2023-10-15T23:20:06Z","timestamp":1697412006000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1046\/j.1365-2265.2000.00964.x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2000,3]]},"references-count":41,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2000,3]]}},"alternative-id":["10.1046\/j.1365-2265.2000.00964.x"],"URL":"https:\/\/doi.org\/10.1046\/j.1365-2265.2000.00964.x","archive":["Portico"],"relation":{},"ISSN":["0300-0664","1365-2265"],"issn-type":[{"value":"0300-0664","type":"print"},{"value":"1365-2265","type":"electronic"}],"subject":[],"published":{"date-parts":[[2000,3]]}}}