Pituitary

, Volume 16, Issue 1, pp 46–55 | Cite as

Mortality and morbidity in adult craniopharyngioma

  • Eva Marie Erfurth
  • Helene Holmer
  • Sigridur Bara Fjalldal
Article
First Online:

Abstract

A craniopharyngioma (CP) is an embryonic malformation of the sellar and parasellar region. The annual incidence is 0.5–2.0 cases/million/year and approximately 60 % of CP are seen in adulthood. Craniopharyngiomas have the highest mortality of all pituitary tumors. Typical initial manifestations at diagnosis in adults are visual disturbances, hypopituitarism and symptoms of elevated intracranial pressure. The long-term morbidity is substantial with hypopituitarism, increased cardiovascular risk, hypothalamic damage, visual and neurological deficits, reduced bone health, and reduction in quality of life and cognitive function. Therapy of choice is surgery, followed by cranial radiotherapy in about half of the patients. The standardised overall mortality rate varies 2.88–9.28 in cohort studies. Patients with CP have a 3–19 fold higher cardiovascular mortality in comparison to the general population. Women with CP have an even higher risk.

Keywords

Mortality Morbidity Hypothalamic damage Hypopituitarism Cardiovascular risk Quality of life Cognitive function 
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Notes

Acknowledgments

This work was supported by The Swedish Research Council (Grant no K 2002-72X-14257-01), the Swedish Children’s Cancer Foundation, the Medical Faculty, Lund University, Sweden.

Conflict of interest

EM Erfurth is a member of Eli Lilly and Company Advisory Board, all other authors have nothing to disclose.

References

  1. 1.
    Bülow B, Attewell R, Hagmar L, Malmstrom P, Nordstrom CH, Erfurth EM (1998) Postoperative prognosis in craniopharyngioma with respect to cardiovascular mortality, survival, and tumour recurrence. J Clin Endocrinol Metab 11:3897–3904CrossRefGoogle Scholar
  2. 2.
    Bunin GR, Surawicz TS, Witman PA, Preston-Martin S, Davis F, Bruner JM (1998) The descriptive epidemiology of craniopharyngioma. J Neurosurg 89(4):547–551PubMedCrossRefGoogle Scholar
  3. 3.
    Müller HL (2012) Childhood craniopharyngioma. Pituitary [Epub ahead of print]Google Scholar
  4. 4.
    De Vile CJ, Grant DB, Hayward RD, Stanhope R (1996) Growth and endocrine sequelae of craniopharyngioma. Arch Dis Child 75:108–114CrossRefGoogle Scholar
  5. 5.
    Müller HL, Emser A, Faldum A, Bruhnken G, Etavard-Gorris N, Gebhardt U, Oeverink R, Kolb R, Sorensen N (2004) Longitudinal study on growth and body mass index before and after diagnosis of childhood craniopharyngioma. J Clin Endocrinol Metab 89:3298–3305PubMedCrossRefGoogle Scholar
  6. 6.
    Tomlinson JW, Holden N, Hills RK, Wheatley K, Clayton RN, Bates AS, Sheppard MC, Stewart PM (2001) Association between premature mortality and hypopituitarism. Lancet 357:425–431PubMedCrossRefGoogle Scholar
  7. 7.
    Karavitaki N, Cudlip S, Adams CB, Wass JA (2006) Craniopharyngiomas. Endocr Rev 27:371–397PubMedCrossRefGoogle Scholar
  8. 8.
    Van Effenterre R, Boch AL (2002) Craniopharyngioma in adults and children: a study of 122 surgical cases. J Neurosurg 97(1):3–11PubMedCrossRefGoogle Scholar
  9. 9.
    Karavitaki N, Brufani C, Warner JT, Adams CB, Richards P, Ansorge O, Shine B, Turner HE, Wass JA (2005) Craniopharyngiomas in children and adults: systematic analysis of 121 cases with long-term follow-up. Clin Endocrinol (Oxf) 62(4):397–409CrossRefGoogle Scholar
  10. 10.
    Crowley RK, Hamnvik OP, O’Sullivan EP, Behan LA, Smith D, Agha A, Thompson CJ (2010) Morbidity and mortality in patients with craniopharyngioma after surgery. Clin Endocrinol (Oxf) 73(4):516–521. doi: 10.1111/j.1365-2265.2010.03838.x Google Scholar
  11. 11.
    Visser J, Hukin J, Sargen M, Steinbok P, Goddard K, Fryer C (2010) Late mortality in pediatric patients with craniopharyngioma. J Neurooncol 100:105–111PubMedCrossRefGoogle Scholar
  12. 12.
    Stripp DC, Maity A, Janss AJ, Belasco JB, Tochner ZA, Goldwein JW, Moshang T, Rorke LB, Phillips PC, Sutton LN, Shu HK (2004) Surgery with or without radiation therapy in the management of craniopharyngiomas in children and young adults. Int J Radiat Oncol Biol Phys 58(3):714–720PubMedCrossRefGoogle Scholar
  13. 13.
    Rajan B, Ashley S, Gorman C, Jose CC, Horwich A, Bloom HJ, Marsh H, Brada M (1993) Craniopharyngioma-a long-term results following limited surgery and radiotherapy. Radiother Oncol 26(1):1–10PubMedCrossRefGoogle Scholar
  14. 14.
    Pereira AM, Schmid EM, Schutte PJ, Voormolen JH, Biermasz NR, van Thiel SW, Corssmit EP, Smit JW, Roelfsema F, Romijn JA (2005) High prevalence of long-term cardiovascular, neurological and psychosocial morbidity after treatment for craniopharyngioma. Clin Endocrinol (Oxf) 62:197–204CrossRefGoogle Scholar
  15. 15.
    Rosén T, Bengtsson BA (1990) Premature mortality due to cardiovascular disease in hypopituitarism. Lancet 336(8710):285–288PubMedCrossRefGoogle Scholar
  16. 16.
    Bülow B, Hagmar L, Mikoczy Z, Nordström CH, Erfurth EM (1990) Increased cerebrovascular mortality in patients with hypopituitarism. Clin Endocrinol (Oxf) 46(1):75–81CrossRefGoogle Scholar
  17. 17.
    Erfurth EM, Bülow B, Svahn-Tapper G, Norrving B, Odh K, Mikoczy Z, Björk J, Hagmar L (2002) Risk factors for cerebrovascular deaths in patients operated and irradiated for pituitary tumors. J Clin Endocrinol Metab 87(11):4892–4899PubMedCrossRefGoogle Scholar
  18. 18.
    Barrett-Connor E (2003) Clinical review 162: cardiovascular endocrinology 3: an epidemiologist looks at hormones and heart disease in women. J Clin Endocrinol Metab 88:4031–4042PubMedCrossRefGoogle Scholar
  19. 19.
    Anderson GL, Limacher M, Assaf AR, Bassford T, Beresford SA, Black H, Bonds D, Brunner R, Brzyski R, Caan B, Chlebowski R, Curb D, Gass M, Hays J, Heiss G, Hendrix S, Howard BV, Hsia J, Hubbell A, Jackson R, Johnson KC, Judd H, Kotchen JM, Kuller L, LaCroix AZ, Lane D, Langer RD, Lasser N, Lewis CE, Manson J, Margolis K, Ockene J, O’Sullivan MJ, Phillips L, Prentice RL, Ritenbaugh C, Robbins J, Rossouw JE, Sarto G, Stefanick ML, Van Horn L, Wactawski-Wende J, Wallace R, Wassertheil-Smoller S, Women’s Health Initiative Steering Committee (2004) Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women’s Health Initiative randomized controlled trial. JAMA 14:1701–1712Google Scholar
  20. 20.
    Sutton LN, Gusnard D, Bruce DA, Fried A, Packer RJ, Zimmerman RA (1991) Fusiform dilatations of the carotid artery following radical surgery of childhood craniopharyngiomas. J Neurosurg 74:695–700PubMedCrossRefGoogle Scholar
  21. 21.
    Brada M, Ashley S, Ford D, Traish D, Burchell L, Rajan B (2002) Cerebrovascular mortality in patients with pituitary adenoma. Clin Endocrinol (Oxf) 57:713–717CrossRefGoogle Scholar
  22. 22.
    Kalapurakal JA (2005) Radiation therapy in the management of pediatric craniopharyngiomas-a review. Child’s Nerv Syst 21:808–816CrossRefGoogle Scholar
  23. 23.
    Molitch ME, Clemmons DR, Malozowski S, Merriam GR, Vance ML, Endocrine Society (2011) Evaluation and treatment of adult growth hormone deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 96(6):1587–1609PubMedCrossRefGoogle Scholar
  24. 24.
    Maison P, Griffin S, Nicoue-Beglah M, Haddad N, Balkau B, Chanson P (2004) Impact of growth hormone (GH) treatment on cardiovascular risk factors in GH-deficient adults: a meta-analysis of blinded, randomized, placebo-controlled trials. J Clin Endocrinol Metab 89:2192–2199PubMedCrossRefGoogle Scholar
  25. 25.
    Sherlock M, Reulen RC, Alonso AA, Ayuk J, Clayton RN, Sheppard MC, Hawkins MM, Bates AS, Stewart PM (2009) ACTH deficiency, higher doses of hydrocortisone replacement, and radiotherapy are independent predictors of mortality in patients with acromegaly. J Clin Endocrinol Metab 94(11):4216–4223PubMedCrossRefGoogle Scholar
  26. 26.
    Bergthorsdottir R, Leonsson-Zachrisson M, Odén A, Johannsson G (2006) Premature mortality in patients with Addison’s disease: a population-based study. J Clin Endocrinol Metab 91(12):4849–4853PubMedCrossRefGoogle Scholar
  27. 27.
    Owen PJ, Lazarus JH (2003) Subclinical hypothyroidism: the case for treatment. Trends Endocrinol Metab 14:257–261PubMedCrossRefGoogle Scholar
  28. 28.
    Bülow B, Hagmar L, Eskilsson J, Erfurth EM (2000) Hypopituitary females have a high incidence of cardiovascular morbidity and an increased prevalence of cardiovascular risk factors. J Clin Endocrinol Metab 85:574–584PubMedCrossRefGoogle Scholar
  29. 29.
    Bray GA, Gallagher TF Jr (1975) Manifestations of hypothalamic obesity in man: a comprehensive investigation of eight patients and a review of the literature. Medicine (Baltimore) 54(4):301–330CrossRefGoogle Scholar
  30. 30.
    Holmer H, Ekman B, Björk J, Nordstöm CH, Popovic V, Siversson A, Erfurth EM (2009) Hypothalamic involvement predicts cardiovascular risk in adults with childhood onset craniopharyngioma on long-term GH therapy. Eur J Endocrinol 161(5):671–679PubMedCrossRefGoogle Scholar
  31. 31.
    Bray GA, Inoue S, Nishizawa Y (1981) Hypothalamic obesity. The autonomic hypothesis and the lateral hypothalamus. Diabetologia 20(Suppl):366–377PubMedCrossRefGoogle Scholar
  32. 32.
    Verhelst J, Kendall-Taylor P, Erfurth EM, Price DA, Geffner M, Koltowska-Häggström M, Jönsson PJ, Wilton P, Abs R (2005) Baseline characteristics and response to 2 years of growth hormone (GH) replacement of hypopituitary patients with GH deficiency due to adult-onset craniopharyngioma in comparison with patients with nonfunctioning pituitary adenoma: data from KIMS (Pfizer International Metabolic Database). J Clin Endocrinol Metab 90(8):4636–4643PubMedCrossRefGoogle Scholar
  33. 33.
    Trivin C, Busiah K, Mahlaoui N, Recasens C, Souberbielle JC, Zerah M, Sainte-Rose C, Brauner R (2009) Childhood craniopharyngioma: greater hypothalamic involvement before surgery is associated with higher homeostasis model insulin resistance index. BMC Pediatr 9:24PubMedCrossRefGoogle Scholar
  34. 34.
    Duff J, Meyer FB, Ilstrup DM, Laws ER Jr, Schleck CD, Scheithauer BW (2000) Long-term outcomes for surgically resected craniopharyngiomas. Neurosurgery 46(2):291–302PubMedCrossRefGoogle Scholar
  35. 35.
    Hetelekidis S, Barnes PD, Tao ML, Fischer EG, Schneider L, Scott RM, Tarbell NJ (1993) 20-year experience in childhood craniopharyngioma. Int J Radiat Oncol Biol Phys 27:189–195PubMedCrossRefGoogle Scholar
  36. 36.
    Holmer H, Pozarek G, Wirfält E, Popovic V, Ekman B, Björk J, Erfurth EM (2010) Reduced energy expenditure and impaired feeding-related signals but not high energy intake reinforces hypothalamic obesity in adults with childhood onset craniopharyngioma. J Clin Endocrinol Metab 95(12):5395–5402PubMedCrossRefGoogle Scholar
  37. 37.
    Roth C, Wilken B, Hanefels F, Schröter W, Leonhardt U (1998) Hyperphagia in children with craniopharyngioma is associated with hyperleptinaemia and a failure in the downregulation of appetite. Eur J Endocrinol 138:89–91PubMedCrossRefGoogle Scholar
  38. 38.
    Kreier F, Fliers E, Voshol PJ, Van Eden CG, Havekes LM, Kalsbeek A, Van Heijningen CL, Sluiter AA, Mettenleiter TC, Romijn JA, Sauerwein HP, Buijs RM (2002) Selective parasympathetic innervation of subcutaneous and intra-abdominal fat-functional implications. J Clin Invest 110(9):1243–1250PubMedGoogle Scholar
  39. 39.
    Lustig RH (2002) Hypothalamic obesity: the sixth cranial endocrinopathy. Endocrinologist 12:210–217CrossRefGoogle Scholar
  40. 40.
    Shaikh MG, Grundy RG, Kirk JM (2008) Reductions in basal metabolic rate and physical activity contribute to hypothalamic obesity. J Clin Endocrinol Metab 93:2588–2593PubMedCrossRefGoogle Scholar
  41. 41.
    Harz KJ, Müller HL, Waldeck E, Pudel V, Roth C (2003) Obesity in patients with craniopharyngioma: assessment of food intake and movement counts indicating physical activity. J Clin Endocrinol Metab 88:5227–5231PubMedCrossRefGoogle Scholar
  42. 42.
    Smith D, Finucane F, Phillips J, Baylis PH, Finucane J, Tormey W, Thompson CJ (2004) Abnormal regulation of thirst and vasopressin secretion following surgery for craniopharyngioma. Clin Endocrinol (Oxf) 61:273–279CrossRefGoogle Scholar
  43. 43.
    Griffiths AP, Henderson M, Penn ND, Tindall H (1988) Haematological, neurological and psychiatric complications of chronic hypothermia following surgery for craniopharyngioma. Postgrad Med J 64(754):617–620PubMedCrossRefGoogle Scholar
  44. 44.
    Crowley RK, Woods C, Fleming M, Rogers B, Behan LA, O’Sullivan EP, Kane T, Agha A, Smith D, Costello RW, Thompson CJ (2011) Somnolence in adult craniopharyngioma patients is a common, heterogeneous condition that is potentially treatable. Clin Endocrinol (Oxf) 74(6):750–755CrossRefGoogle Scholar
  45. 45.
    van der Klaauw AA, Biermasz NR, Pereira AM, van Kralingen KW, Dekkers OM, Rabe KF, Smit JW, Romijn JA (2008) Patients cured from craniopharyngioma or nonfunctioning pituitary macroadenoma (NFMA) suffer similarly from increased daytime somnolence despite normal sleep patterns compared to healthy controls. Clin Endocrinol (Oxf) 69(5):769–774CrossRefGoogle Scholar
  46. 46.
    Rehman HU, Atkin SL (1999) Sleep disturbances and cardiac arrhythmia after treatment of a craniopharyngioma. J R Soc Med 92(11):585–586PubMedGoogle Scholar
  47. 47.
    Mong S, Pomeroy SL, Cecchin F, Juraszek A, Alexander ME (2008) Cardiac risk after craniopharyngioma therapy. Pediatr Neurol 38(4):256–260PubMedCrossRefGoogle Scholar
  48. 48.
    Cabezudo Artero JM, Vaquero Crespo J, Bravo Zabalgoitia G (1984) Status of vision following surgical treatment of craniopharyngiomas. Acta Neurochir (Wien) 73(3–4):165–177CrossRefGoogle Scholar
  49. 49.
    Harris JR, Levene MB (1976) Visual complications following irradiation for pituitary adenomas and craniopharyngiomas. Radiology 120(1):167–171PubMedGoogle Scholar
  50. 50.
    Drake WM, Carroll PV, Maher KT, Metcalfe KA, Camacho-Hubner C, Shaw NJ, Dunger DB, Cheetham TD, Savage MO, Monson JP (2003) The effect of cessation of growth hormone (GH) therapy on bone mineral accretion in GH-deficient adolescents at the completion of linear growth. J Clin Endocrinol Metab 88:1658–1663PubMedCrossRefGoogle Scholar
  51. 51.
    Boot AM, van der Sluis IM, Krenning EP, de Muinck Keizer-Schrama SM (2007) Bone mineral density and body composition in adolescents with childhood-onset growth hormone deficiency. Horm Res 1:364–367Google Scholar
  52. 52.
    Sävendahl L (2005) Hormonal regulation of growth plate cartilage. Horm Res 64(Suppl 2):94–97PubMedGoogle Scholar
  53. 53.
    Wark JD (1996) Osteoporotic fractures: background and prevention strategies. Maturitas 23:193–207. ReviewGoogle Scholar
  54. 54.
    Felson DT, Zhang Y, Hannan MT, Anderson JJ (1993) Effects of weight and body mass index on bone mineral density in men and women: the Framingham study. J Bone Miner Res 8:567–573PubMedCrossRefGoogle Scholar
  55. 55.
    Hamrick MW, Ferrari SL (2008) Leptin and the sympathetic connection of fat to bone. Osteoporos Int Rev 19:905–912CrossRefGoogle Scholar
  56. 56.
    Do Prado WL, de Piano A, Lazaretti-Castro M, de Mello MT, Stella SG, Tufik S, do Nascimento CM, Oyama LM, Lofrano MC, Tock L, Caranti DA, Dâmaso AR (2009) Relationship between bone mineral density, leptin and insulin concentration in Brazilian obeses adolscents. J Bone Miner Metab 27:613–619PubMedCrossRefGoogle Scholar
  57. 57.
    Müller HL, Schneider P, Bueb K, Etavard-Gorris N, Gebhardt U, Kolb R, Sörensen N (2003) Volumetric bone mineral density in patients with childhood craniopharyngioma. Exp Clin Endocrinol Diabetes 111:168–173PubMedCrossRefGoogle Scholar
  58. 58.
    Holmer H, Popovic V, Ekman B, Follin C, Siversson A-B, Erfurth EM (2011) Hypothalamic involvement and insufficient sex steroid supplementation are associated with low bone mineral density in women with childhood onset craniopharyngioma. Eur J Endocrinol 165:25–31PubMedCrossRefGoogle Scholar
  59. 59.
    Guo Y, Zhao LJ, Shen H, Guo Y, Deng HW (2005) Genetic and environmental correlations between age at menarche and bone mineral density at different skeletal sites. Calcif Tissue Int 77:356–360PubMedCrossRefGoogle Scholar
  60. 60.
    Finkelstein JS, Neer RM, Biller BM, Crawford JD, Klibanski AN (1992) Osteopenia in men with a history of delayed puberty. N Eng J Med 326:600–604CrossRefGoogle Scholar
  61. 61.
    Almstedt Shoepe H, Snow CM (2005) Oral contraceptive use in young women is associated with lower bone mineral density than that of controls. Osteoporos Int 16:1538–1544PubMedCrossRefGoogle Scholar
  62. 62.
    Saag KG (2003) Glucocorticoid-induced osteoporosis. Endocrinol and Metab Clin North Am 32:135–157CrossRefGoogle Scholar
  63. 63.
    Mora S, Saggion F, Russo G, Weber G, Bellini A, Prinster C, Chiumello G (1996) Bone density in young patients with congenital adrenal hyperplasia. Bone 18:337–340PubMedCrossRefGoogle Scholar
  64. 64.
    Karsenty G, Oury F (2010) The central regulation of bone mass, the first link between bone remodeling and energy metabolism. J Clin Endocrinol Metab 95(11):4795–4801. ReviewGoogle Scholar
  65. 65.
    Poretti A, Grotzer MA, Ribi K, Schönle E, Boltshauser E (2004) Outcome of craniopharyngioma in children: long-term complications and quality of life. Dev Med Child Neurol 6(4):220–229Google Scholar
  66. 66.
    Friedman MA, Meyers CA, Sawaya R (2008) Neuropsychological effects of third ventricle tumor surgery. Neurosurgery 62(6 Suppl 3):1093–1100PubMedGoogle Scholar
  67. 67.
    Donnet A, Schmitt A, Dufour H, Grisoli F (1999) Neuropsychological follow-up of twenty two adult patients after surgery for craniopharyngioma. Acta Neurochir (Wien) 141(10):1049–1054CrossRefGoogle Scholar
  68. 68.
    Carpentieri SC, Waber DP, Scott RM, Goumnerova LC, Kieran MW, Cohen LE, Kim F, Billett AL, Tarbell NJ, Pomeroy SL (2001) Memory deficits among children with craniopharyngiomas. Neurosurgery 49(5):1053–1057PubMedGoogle Scholar
  69. 69.
    Anderson CA, Wilkening GN, Filley CM, Reardon MS, Kleinschmidt-DeMasters BK (1997) Neurobehavioral outcome in pediatric craniopharyngioma. Pediatr Neurosurg 26(5):255–260PubMedCrossRefGoogle Scholar
  70. 70.
    Ondruch A, Maryniak A, Kropiwnicki T, Roszkowski M, Daszkiewicz P (2011) Cognitive and social functioning in children and adolescents after the removal ofcraniopharyngioma. Childs Nerv Syst 27(3):391–397PubMedCrossRefGoogle Scholar
  71. 71.
    Kawamata T, Amano K, Aihara Y, Kubo O, Hori T (2010) Optimal treatment strategy for craniopharyngiomas based on long-term functional outcomes of recent and past treatment modalities. Neurosurg Rev 33(1):71–81PubMedCrossRefGoogle Scholar
  72. 72.
    Honegger J, Barocka A, Sadri B, Fahlbusch R (1998) Neuropsychological results of craniopharyngioma surgery in adults: a prospective study. Surg Neurol 50(1):19–28PubMedCrossRefGoogle Scholar
  73. 73.
    Merchant TE, Kiehna EN, Sanford RA, Mulhern RK, Thompson SJ, Wilson MW, Lustig RH, Kun LE (2002) Craniopharyngioma: the St. Jude Children’s Research Hospital experience 1984–2001. Int J Radiat Oncol Biol Phys 1;53(3):533–542Google Scholar
  74. 74.
    Schubert T, Trippel M, Tacke U, van Velthoven V, Gumpp V, Bartelt S, Ostertag C, Nikkhah G (2009) Neurosurgical treatment strategies in childhood craniopharyngiomas: is less more? Childs Nerv Syst 25(11):1419–1427PubMedCrossRefGoogle Scholar
  75. 75.
    Hofmann BM, Höllig A, Strauss C, Buslei R, Buchfelder M, Fahlbusch R (2012) Results after treatment of craniopharyngiomas: further experiences with 73 patients since 1997. J Neurosurg 116(2):373–384PubMedCrossRefGoogle Scholar
  76. 76.
    Pedreira CC, Stargatt R, Maroulis H, Rosenfeld J, Maixner W, Warne GL, Zacharin MR (2006) Health related quality of life and psychological outcome in patients treated for craniopharyngiomain childhood. J Pediatr Endocrinol Metab 19(1):15–24PubMedCrossRefGoogle Scholar
  77. 77.
    Mortini P, Losa M, Pozzobon G, Barzaghi R, Riva M, Acerno S, Angius D, Weber G, Chiumello G, Giovanelli M (2011) Neurosurgical treatment of craniopharyngioma in adults and children: early and long-term results in a large case series. J Neurosurg 114(5):1350–1359PubMedGoogle Scholar
  78. 78.
    Dekkers OM, Biermasz NR, Smit JW, Groot LE, Roelfsema F, Romijn JA, Pereira AM (2006) Quality of life in treated adult craniopharyngioma patients. Eur J Endocrinol 154(3):483–489PubMedCrossRefGoogle Scholar
  79. 79.
    Sands SA, Milner JS, Goldberg J, Mukhi V, Moliterno JA, Maxfield C, Wisoff JH (2005) Quality of life and behavioral follow-up study of pediatric survivors of craniopharyngioma. J Neurosurg 103(4 Suppl):302–311PubMedGoogle Scholar
  80. 80.
    Bengtsson B-Å, Edén S, Lönn L, Kvist H, Stokland A, Lindstedt G, Bosaeus I, Tölli J, Sjöström L, Isaksson O (1993) Treatment of adults with growth hormone (GH) deficiency with recombinant human GH. J Clin Endocrinol Metab 76:309–317PubMedCrossRefGoogle Scholar
  81. 81.
    Burman P, Broman J, Hetta J, Wiklund I, Erfurth E, Hägg E, Karlsson F (1995) Quality of life in adults with growth hormone (GH) deficiency: response to treatment with recombinant human GH in a placebo-controlled 21-month trial. J Clin Endocrinol Metab 80:3585–3590PubMedCrossRefGoogle Scholar
  82. 82.
    Rosilio M, Blum W, Edwards D, Shavrikova E, Valle D, Lamberts S, Erfurth E-M, Webb S, Ross R, Chihara K, Henrich G, Herschbach P, Attanasio A (2004) Long-term improvement of quality of life during growth hormone (GH) replacement therapy in adults with GH deficiency, as measured by questions on life satisfaction-hypopituitarism (QLS-H). J Clin Endocrinol Metab 89:1684–1693PubMedCrossRefGoogle Scholar
  83. 83.
    McGauley G (2000) The psychological consequences and quality of life in adults with growth hormone deficiency. Growth Horm IGF Res 10(Suppl B):S63–S68PubMedCrossRefGoogle Scholar
  84. 84.
    Gilchrist FJ, Murray RD, Shalet SM (2002) The effect of long-term untreated growth hormone deficiency (GHD) and 9 years of GH replacement on the quality of life (QoL) of GH-deficient adults. Clin Endocrinol (Oxf) 57(3):363–370CrossRefGoogle Scholar
  85. 85.
    Baum H, Katznelson L, Sherman J, Biller B, Hayden D, Schoenfeld D, Cannistraro K, Klibanski A (1998) Effects of physiological growth hormone (GH) therapy on cognition and quality of life in patients with adult-onset GH deficit. J Clin Endocrinol Metab 83:3184–3189PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Eva Marie Erfurth
    • 1
  • Helene Holmer
    • 2
  • Sigridur Bara Fjalldal
    • 1
  1. 1.Department of EndocrinologySkånes University HospitalLundSweden
  2. 2.Department of Internal MedicineCentralsjukhusetKristianstadSweden

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