Update in Mortality in GH treated patients.

During GH therapy for 2.3-9.6 years a male adult onset (AO) GH deficient (GHD) patient with a diagnosis of a non-functioning adenoma, have no increased all-cause mortality. However, women with AO GHD are still at a slightly higher risk. This general improvement in mortality is due to; more contemporary regiment of cardiovascular drugs, a refinement of surgical procedures, besides GH therapy improved hormone replacement regimens with lowered glucocorticoid replacement, and updated approaches of sex steroids for women, and less use of cranial radiotherapy. The underlying disease is the most important predictor for mortality: e.g. a craniopharyngioma, malignant causes of hypopituitarism, previous Cushing's disease, presence of diabetes insipidus/aggressive tumors. The main cause of increased mortality was cerebrovascular diseases and of infectious/repiratory diseases in ACTH deficient patients. Further, there was a significant impact of young age at disease onset and of death from secondary brain tumors, with a higher risk after cranial radiotherapy.Four cohorts of GH treated childhood onset (CO) GHD patients have been published. Two of them included only patients with idiopathic isolated GH deficiency (IGHD), neurosecretory dysfunction, idiopathic short stature (ISS) or born short for gestational age (SGA). Increased mortality in circulatory disorders, ill defined diseases and bone cancer was recorded in one, but not in the other smaller study, where suicide and accidents caused the majority of deaths. A third CO GHD cohort included patients with a background of malignant tumors, craniopharyngioma, pituitary adenomas, pituitary aplasia/hypoplasia, and trauma. An increase of all cause mortality was recorded in both males and females. The fourth cohort included IGHD and ISS (60%), but also diagnosis e.g. chronic renal failure, and Turner's syndrome. In these latter studies an underlying serious condition was the most important factor for death, with CNS tumors (recurrent or new tumor) being the leading cause of mortality