Background: Adult growth hormone deficiency (AGHD) is a debilitating condition characterized by both clinical symptoms, in particular alterations in body composition such as increased abdominal and visceral adiposity, adverse change in lipid and carbohydrate metabolism, and reduction of bone mineral density, and psychological and behavioral impairments, leading to a decreased quality of life (QoL). Moreover, considering that AGHD may be related to loss of sexual desire, erectile dysfunction and infertility, the evaluation of sexual function could be included in the assessment of AGHD patients’ well-being.
Aim: To compare baseline outcomes concerning body composition, biochemical/hormonal data, QoL and sexual well-being among patients with AGHD referring to a single endocrinological center and grouped according to their history of r-hGH therapy.
Methods: The Management of Adult Growth Hormone Deficiency Study (MAGHD) is a prospective, single-center trial aiming to improve AGHD management through a smartphone app (MAGHD App) and a wearable device integrated with a software framework able to merge several kind of patients’ daily data with clinical data collected in institutional databases.
Up-to-now, a total of 83 subjects (31 Female, 52 Male, mean age 56.27+14.68 years) with AGHD were enrolled in the study. According to r-hGH therapy, they were divided in 3 groups: patients on long-term r-hGH therapy (Group 1, n=32), patients previously treated with r-hGH (Group 2, n=20), patients never treated (Group 3, n=31). Each patient has completed the baseline visit, including clinical, biochemical and psychological assessment, moreover data on BMD and body composition were obtained by DXA. Specific questionnaires were adopted for evaluating the global well-being: QoL was assessed through QLS-H and QoL-AGHDA, while sexual function was evaluated through IIEF-15 and FSFI, for males and females respectively. The nonparametric Kruskal-Wallis test was used for comparison among 3 groups and data are expressed as median.
Results: Mean age at AGHD diagnosis was 43.18±17.64 (lower in Group 1 compared to Group 2 and 3, p<0.05), while mean duration of AGHD was 155.08±123.32 months (lower in Group 3 compared to both Group 1 and 2, p<0.05).
Considering anthropometric parameters, waist circumference (Group1 95cm; Group2 96,5cm; Group3 109cm), total fat mass (Group1 25016g; Group2 26491g; Group3 33887g) and trunk fat mass (Group1 11743g; Group2 12598g; Group3 16761g) were significantly higher in Group3 compared to both Group2 and 1 (p<0.05), while total fat mass and trunk fat mass did not differ significantly among Group1 and 2. Serum insulin and total body fat (%) were significantly higher in Group3 than Group1 (p<0.05). IGF-1 and IGFBP3 were significantly higher in Group1 compared to both Group2 and 3 (p<0.0001). BMD, circulating lipids, and fasting glucose did not differ among the 3 groups.
Considering questionnaires’ results, treated patients gained better scores at QLS-H (p=0.042), even if no statistically significant differences were found at QoL-AGHDA (p=0.684). Moreover, males with ongoing r-hGH therapy (Group 1) showed higher scores (better results) in all the 5 domains of IIEF-15 compared to not-treated males (Group 2 and Group 3). Even in females the scores of the FSFI were better in the r-hGH treated group.
Conclusions: In AGHD patients, while r-hGH therapy seems to confer a long-lasting beneficial effect on body fat, especially trunk fat, even after its discontinuation, it seems to improve QoL and sexual function only in patients with ongoing treatment. Furthermore, this study confirms the importance of evaluating QoL in AGHD patients and suggests that sexual well-being is an important aspect whose assessment should always be integrated in the global evaluation of these patients.