Application of the AGHDA score to determine efficacy of therapy in adult patients on growth hormone replacement in the south west of Ireland

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: MON 167-198-Hypothalamus-Pituitary Development & Biology
Monday, June 17, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board MON-193
Colm Kerr*1, Ruth Casey2, Antoinette A Tuthill1 and Domhnall Jude O'Halloran3
1Cork University Hospital, Cork, Ireland, 2Cork Univ Hospital, Cork, Ireland, 3Cork Univ Hosp, Cork, Ireland
Local and International standards on the use of growth hormone (GH) replacement in GH deficient adults is variable. In 2003, the UK National Institute for Clinical Excellence (NICE) established guidelines on the use of GH therapy in adults. These guidelines state that recombinant GH should be used only for adults with a severe GH deficiency that severely affects their quality of life.  The “Assessment of Growth Hormone Deficiency in Adults” (AGHDA) questionnaire has been validated as a tool to calculate a patient’s quality of life score. A recorded AGHDA score of 11 or more in the setting of severe GH deficiency warrants the administration of GH. Treatment is stopped if a follow up AGHDA score does not improve by at least 7 after 1 year of GH treatment. The aim of this audit was to investigate the use of AGHDA scores in the treatment of adult GH deficient patients in our institution.

A retrospective study of patient case records was carried out. A total of 39 adult patients on GH therapy were included. The cause of GH deficiency in 82% of patients was a sellar tumour, congenital GH deficiency in 8%, non-sellar brain tumour in 3%, Sheehan’s syndrome in 3% and cause miscellaneous in 5%. 28 (72%) had baseline AGHDA’s documented. Of the 28 with baseline AGHDA scores, 11 (39%) had a follow up AGHDA score documented within a year of growth hormone treatment. 21 (75%) met the 2003 NICE criteria for GH replacement based on their baseline AGHDA score. Of the 11 with baseline and 1 year AGHDA scores, 5 (45%) warranted continued GH replacement therapy based on their 1 year AGHDA score. The mean baseline AGHDA score was 15 (SD 6.1) and at 1 year was 11.3 (SD 7.3). The average dose of recombinant GH taken daily by adult patients was 0.39mg.

In this study, 75% of the audit population with baseline AGHDA scores documented met the 2003 NICE guideline criteria for GH replacement. However, over a quarter of the audit population did not have a baseline AGHDA documented. 1 year follow up AGHDA scores were documented in less than half of patients who had baseline AGHDA scores documented. In those that had baseline and follow up AGHDA scores documented, over half the patients who continued to receive GH replacement did not meet the NICE guidelines criteria for continuing therapy. This highlights the need for diligent examination and follows up of repeat AGHDA scores to ensure that patients are benefiting from GH treatment and that cost effective measures are observed.

Nothing to Disclose: CK, RC, AAT, DJO

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