Psychological Wellbeing And Quality Of Life

The psychological well-being and quality of life (QoL) of GH-deficient patients and the effects of GH replacement have been addressed in several studies. In the majority, self-perceived well-being, and QoL have been assessed using validated questionnaires, and comparisons have been made with healthy control subjects of similar age, sex and socioeconomic status. Although several instruments have been used in these trials the results have been remarkably consistent.

Decreased psychological well-being has been reported in hypopituitary adults despite replacement of all hormone deficiencies with the exception of GH (2). In studies comparing adults with long standing GH-deficiency with matched controls the patients reported lower openness, less assertiveness, less energy, greater emotional lability, more difficulties with sexual relationships and a greater sense of social isolation (2,3). Evi dence from a recent study suggests that the severity of psychological distress correlates positively with the duration of GH-deficiency (4).

McGauley was the first to demonstrate in a double-blind placebo-controlled study that GH replacement (0.5 IU/kg/wk; 25 ^g/kg/d) was associated with an improvement in mood and energy levels in GH-deficient adults (5). These findings have been confirmed in subsequent studies (4,24). Whitehead et al. (6) examined the effects of GH replacement (0.25 IU/kg/wk; 12.5 ^g/kg/d) on well-being of 14 adults with GH-deficiency in a 6-mo double-blind placebo-controlled crossover trial, using the Nottingham Health Profile and the Psychological General Well-Being Schedule. In contrast, no significant changes in psychological well-being were observed, but in this study many patients failed to demonstrate a rise in circulating insulin-like growth factor-1 (IGF-1), indicating that noncom-pliance may have contributed to this lack of effect.

The direct mechanism behind alterations in perceived QoL remain unknown. Recently GH treatment of GH-deficient adults has been shown to alter levels of vasoactive intestinal polypeptide and the dopamine metabolite, homovanillic acid, as well as elevating P-endorphin levels in cerebrospinal fluid, but whether these changes are responsible for improvement in mood and well-being is not yet known (7). GH, IGF-1, and the IGF-binding proteins may have direct effects on the nervous system. In addition abnormal sleep patterns have been described in GH-deficient adults with a restoration to normal patterns following GH replacement (8).

In summary adults with GH-deficiency report reduced self-perceived psychological well-being compared with matched healthy subjects. GH replacement results in significant improvements in QoL and psychological well-being in patients with long standing GH-deficiency.

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