Authors' objectives:

This study aims to assess the effects of growth hormone replacement therapy in adults with growth hormone deficiency.

Authors' recommendations: While we found a number of randomised trials examining the effects of growth hormone supplementation in adults with growth hormone deficiency, all had problems that compromised their reliability. Firstly, most trials had too few participants and observed too few events. They were not, therefore, powerful enough to exclude effects and also risked finding a spurious effect by chance. Most studies use non-clinical outcomes. Though some markers such as serum cholesterol levels and bone mineral density have been associated with an increased risk of certain clinical conditions, others such as skinfold thickness and body fat have not. While it is possible to speculate that improvements in proxy markers will result in improved clinical outcome, we found no direct evidence for this. It may be that adverse effects of growth hormone would outweigh any effects on risk markers in the long term. The changes in non-clinical outcomes, however, are small and there may be more effective methods of correcting these markers if this is the aim of treatment (for instance, dietary modification or statin therapy for cholesterol reduction). Follow-up of participants in the studies was short (typically no longer than 6 months) meaning that the long-term effects on morbidity are unclear. Similarly, long term effects on proxy markers remain uncertain. The largest study of 148 patients failed to find any clear benefit from growth hormone supplementation, yet minor adverse effects were common. Based on this and the results from the other studies, we found insufficient reliable evidence to support routine growth hormone treatment for adults with growth-hormone deficiency. Larger and longer randomised controlled trials are needed, which focus on clinical outcomes that matter to patients such as a reduction in fracture rates or symptomatic ischaemic heart disease.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.wihrd.soton.ac.uk

Year Published: 2002

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England

Organisation Name: Wessex Institute for Health Research and Development

Contact Address: Pauline King. Wessex Institute for Health Research and Development, Boldrewood Medical School, Bassett Crescent East, Highfield, Southampton. SO16 7PX Tel. +44 1703 595661 Fax +44 1703 595662

Copyright: Bazian Ltd, Wessex Institute for Health Research and Development