Discontinuation of long-term GH treatment in adults with GH deficiency: a survey of UK practice.

OBJECTIVE: We conducted a survey of UK endocrine clinicians between 06/2022 and 08/2022 to understand current practices regarding GH treatment discontinuation in adults with GH deficiency (GHD).

DESIGN AND METHODS: Using Survey Monkey®, a web-based multiple-choice questionnaire was disseminated to the UK Society for Endocrinology membership. It consisted of 15 questions on demographics, number of patients receiving GH and current practice on GH treatment discontinuation.

RESULTS: 102 endocrine clinicians completed the survey; 65 respondents (33 endocrinologists and 32 specialist nurses) indicated active involvement in managing patients with GHD. 27.7% of clinicians were routinely offering a trial of GH discontinuation to adults receiving long-term GH therapy. Only 6% had a clinical guideline to direct such practice. 29.2% stated that GH discontinuation should be routinely offered as an option to patients on long-term treatment; 60% were not clearly in favour or against this approach but stated that it should probably be considered, whilst 9.2% were against. During the GH withdrawal period, most clinicians monitor signs/symptoms (75.4%), measure IGF-1 (84.6%) and complete a quality of life assessment (89.2%).

CONCLUSIONS: The practice of offering a trial of GH discontinuation in GHD adults on long-term GH therapy is highly variable reflecting the lack of high quality evidence. Around a quarter of clinicians offer GH withdrawal for a number of reasons, but only a few have a local clinical guidance. A further 60% of clinicians stated they would probably consider such an approach. Methodologically sound studies underpinning the development of safe and cost-effective guidance are needed.