Lena Wirén

Decreased psychological well-being in adult patients with growth hormone deficiency

OBJECTIVE Besides effects on body composition, bone mineral content and lipid metabolism, GH seems to influence quality of life, according to previous studies of limited numbers of patients with GH deficiency of childhood and adult origin. In this study psychological well‐being was assessed in a large number of patients with GH deficiency of adult origin.

Beneficial effects of long‐term GH replacement therapy on quality of life in adults with GH deficiency

Quality of life tends to be adversely affected in adults with GH deficiency. The aim of this study was to examine changes in quality of life in a large group of GH‐deficient adults receiving long‐term GH replacement therapy.

Application of a disease-specific, quality-of-life measure (QoL-AGHDA) in growth hormone-deficient adults and a random population sample in Sweden: validation of the measure by Rasch analysis†

Growth hormone deficiency (GHD) in adults has been associated with impaired health status and quality of life (QoL) in several studies using generic measures, and in a few studies using recently developed disease‐specific measures. Theoretically, disease‐specific measures may be more sensitive and succinct than generic measures, and hence prove convenient for general use in clinical practice. The present study sought to validate the scaling properties of the disease‐specific QoL‐AGHDA measure through the implementation of Rasch analysis. The study also sought to compare, by using the QoL‐AGHDA, the QoL of a relatively large Swedish cohort of adults with untreated GHD with that of a reference population also from Sweden.

Currently used growth‐promoting treatment of children results in normal bone mass and density. A prospective trial of discontinuing growth hormone treatment in adolescents

BACKGROUND AND AIMS The need for continued GH replacement in patients with childhood‐onset GH deficiency (GHD) into adulthood has been recognized. The consequences of discontinuing GH treatment on bone mineralization in adolescent patients with GHD and short stature were examined over a period of 2 years.

A new self-assessment questionnaire to measure well-being in children, particularly those of short stature

The impact of short stature on children is commonly assessed in terms of psychosocial consequences. Proxy respondents and formal behavioural performance tests constitute standard methods in the evaluation of growth hormone therapy in children of short stature. Therefore, a self-administered, short and simple adjective check-list was developed and tested on 342 children of both sexes, aged 9–13 years. Six dimensions covering alertness, self-esteem, mood, elation, stability and vitality were derived after factor analysis. High internal consistency reliability was found for all dimensions. Modest correlations with height, reaching statistical significance for alertness, mood and vitality, were observed. Girls described themselves as having lower self-esteem and vitality than boys, while boys had lower scores for elation. It was concluded that the measure was relevant and potentially useful in children with short stature.

Growth hormone (GH) replacement in GH-deficient adults: a crossover trial comparing the effect on metabolic control, well-being and compliance of three injections per week versus daily injections

Growth hormone (GH) replacement therapy regimens in adults using daily subcutaneous (sc) injections may not be optimal with respect to carbohydrate and lipid metabolism. The aim of this study was to compare the efficacy of three times weekly injections with daily sc GH injections in terms of serum IGF-I, IGFBPs, lipoprotein levels, serum bone markers, glucose metabolism, body composition, compliance and well-being. Twenty hypopituitary men, 46-76 years, on a course of stable conventional GH replacement therapy for more than 12 months, were included in a 16-week crossover trial. During the first 8 weeks GH was administered three times per week followed by 8 weeks with daily sc injections with the same weekly dose of GH. Fasting serum samples were collected at baseline and on two consecutive days at the end of each 8-week period. Serum IGF-I and IGFBP-3 concentrations were lower both the first and second morning after the last injection during the period with three injections per week. The second morning after the last GH injection in this period the IGF-I/BP-3 ratio, plasma insulin and FFA were lower whereas IGFBP-1 was increased as compared with values obtained during the period with daily injections. Serum Lp(a) levels, body composition, fat distribution, well-being and compliance were not differently affected by the two treatment regimens. These results suggest that the same weekly dose of GH given as three injections per week reduces serum IGF-I and IGFBP-3 levels without affecting Lp(a) levels. The day-to-day variation in glucose metabolism and FFA serum levels differs considerably between the two modes of GH administration.

Growth hormone (GH) replacement therapy in GH-deficient women during pregnancy

objective The present recommendation is to discontinue GH replacement therapy in hypopituitary women, as they become pregnant. We report our experience of managing GH deficiency with GH replacement therapy in pregnant hypopituitary women.

Evaluation of the Quality of Life of Male Snorers Using the Nottingham Health Profile

Many snorers complain of tiredness during the day, but little is known about the impact of snoring on daily life in other respects. The objective of this study was to assess the quality of life of middle-aged men who were heavy snorers. We used the Nottingham Health Profile (NHP), which has been utilized during the last two decades as an instrument for evaluating the influence different medical conditions have on quality of life. Forty-two men (median 45 years, mean BMI 26 kg/m2 and mean Respiratory Disturbance Index 8.6) completed quality of life questionnaires. The answers were compared with those of a population sample of 786 men from the region with the same mean age. There were significant differences between the snorers and the population sample in the total score for quality of life (p=0.001) and the sections about energy (p < 0.001) and emotional reactions (p=0.02). There were highly significant differences in the frequency of health-related problems among the snoring men compared with the population sample in the ability to perform tasks around the home (p < 0.001). social life (p=0.003), family relationship (p < 0.001 ) and sexual life (p=0.001). When the snorers were compared with results reported from patients suffering from other medical conditions (hypertensives, growth hormone deficiency, myocardial infarction, chronic obstructive pulmonary disease), we found an equal level of total mean score and negative influence on their quality of life. The study illustrates that snoring men have a poor quality of life, comparable to that of patients with chronic diseases.

Compromised quality of life in adult patients who have received a radiation dose towards the basal part of the brain. A case-control study in long-term survivors from cancer in the head and neck region

BackgroundAdult patients with hypothalamic-pituitary disorders have compromised quality of life (QoL). Whether this is due to their endocrine consequences (hypopituitarism), their underlying hypothalamic-pituitary disorder or both is still under debate. The aim of this trial was to measure quality of life (QoL) in long-term cancer survivors who have received a radiation dose to the basal part of the brain and the pituitary.MethodsConsecutive patients (n=101) treated for oropharyngeal or epipharyngeal cancer with radiotherapy followed free of cancer for a period of 4 to10 years were identified. Fifteen patients (median age 56 years) with no concomitant illness and no hypopituitarism after careful endocrine evaluation were included in a case-control study with matched healthy controls. Doses to the hypothalamic-pituitary region were calculated. QoL was assessed using the Symptom check list (SCL)-90, Nottingham Health Profile (NHP), and Psychological Well Being (PGWB) questionnaires. Level of physical activity was assessed using the Baecke questionnaire.ResultsThe median accumulated dose was 1.9 Gy (1.5–2.2 Gy) to the hypothalamus and 2.4 Gy (1.8–3.3 Gy) to the pituitary gland in patients with oropharyngeal cancer and 6.0–9.3 Gy and 33.5–46.1 Gy, respectively in patients with epipharyngeal cancer (n=2). The patients showed significantly more anxiety and depressiveness, and lower vitality, than their matched controls.ConclusionIn a group of long time survivors of head and neck cancer who hade received a low radiation dose to the hypothalamic-pituitary region and who had no endocrine consequences of disease or its treatment QoL was compromised as compared with well matched healthy controls.

Different methods for evaluating daytime tiredness in snoring men.

Many snorers complain of daytime tiredness and reduced mental energy. In 42 middle-aged snoring men, the results of sections relating to mental energy in 2 quality-of-life instruments, energy in the Nottingham Health Profile (NHP) and vitality in the Psychological General Well-Being (PGWB) questionnaire, were compared with those of population samples. The snorers were significantly more tired than the population samples ( p <0.001). The scores for the NHP and PGWB were then correlated with a visual analogue scale (VAS) of drowsiness. The correlation coefficient between NHP (energy) and the corresponding VAS value was r =0.52 ( p <0.001). The correlation coefficient between PGWB (vitality) and the VAS value for drowsiness was r =-0.56 ( p <0.001). When nasal breathing was improved with the use of the Nozovent nostril dilator at night for 1 month, NHP (energy) and the VAS value for drowsiness improved significantly ( p <0.001). A single VAS value for drowsiness is a good instrument for evaluating daytime tiredness and for measuring the clinical effect of treatment in snorers.Many snorers complain of daytime tiredness and reduced mental energy. In 42 middle-aged snoring men, the results of sections relating to mental energy in 2 quality-of-life instruments, energy in the Nottingham Health Profile (NHP) and vitality in the Psychological General Well-Being (PGWB) questionnaire, were compared with those of population samples. The snorers were significantly more tired than the population samples (p < 0.001). The scores for the NHP and PGWB were then correlated with a visual analogue scale (VAS) of drowsiness. The correlation coefficient between NHP (energy) and the corresponding VAS value was r = 0.52 (p < 0.001). The correlation coefficient between PGWB (vitality) and the VAS value for drowsiness was r = -0.56 (p <0.001). When nasal breathing was improved with the use of the Nozovent nostril dilator at night for 1 month, NHP (energy) and the VAS value for drowsiness improved significantly (p < 0.001). A single VAS value for drowsiness is a good instrument for evaluating daytime tiredness and for measuring the clinical effect of treatment in snorers.