Potential impacts of adult growth hormone deficiency: a population-based study in England

OBJECTIVES: To investigate the potential long-term impacts of adult growth hormone deficiency (GHD). DESIGN: Observational, retrospective matched cohort. SETTING: UK Clinical Practice Research Datalink (CPRD) Aurum database of primary care records with linkage to deprivation, secondary care and mortality data. PARTICIPANTS: Adults registered with CPRD between 31/03/2002 and 29/03/2021. Individuals with GHD were exact matched up to 1:4 with unaffected controls on sex, age group (by decade) and general practice with propensity score matching on age, ethnicity and deprivation. OUTCOMES: Mortality, cardiovascular disease (CVD), osteoporosis, fractures, depression, time off work and unemployment were investigated using Cox proportional hazards modelling. RESULTS: 1573 adults with GHD were matched to 6234 unaffected controls. Median follow-up was 5.2 years for cases (IQR 2.2, 10.6) and 5.1 years for controls (IQR 2.2, 10.3). Adult GHD was associated with an increased risk of premature mortality (adjusted HR (aHR) 1.61; 95% CI 1.27, 2.03), CVD (aHR 2.38; 95% CI 1.84 to 3.07) and osteoporosis (aHR 4.03; 95% CI 2.88 to 5.65), but there was no evidence for an increased risk of fractures. A higher rate of depression (aHR 1.72; 95% CI 1.23 to 2.40) and unemployment (aHR 2.06; 95% CI 1.56 to 2.71) was also seen in adults with GHD, although there was no evidence for increased time off work. CONCLUSIONS: GHD in adults is associated with increased risk of premature mortality, CVD, osteoporosis, depression and socioeconomic challenges such as unemployment. Timely diagnosis, appropriate treatment and comprehensive support are critical to mitigating these adverse outcomes.