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    Extensive expertise in endocrinology: UK stance on adult GH replacement: the economist vs the endocrinologist.

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    Authors
    Shalet, Stephen M
    Affiliation
    Department of Endocrinology, Christie Hospital NHS Trust, Wilmslow Road, Manchester M20 4BX, UK.
    Issue Date
    2013-10
    
    Metadata
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    Abstract
    In the UK, through the use of a forced economic model, endocrinologists are in the curious position of offering GH replacement to some patients with severe GH deficiency (GHD) but withholding it from other patients with even more severe GHD. This approach is counter-intuitive to endocrine practice in treating endocrine deficiency states. For all other endocrine deficiencies, one would opt for treating those with the most severe biochemical evidence of deficiency first. If this endocrine approach was applied to adult GH replacement in an era of rationing, one would start with the GHD patients with a pathologically low IGF1 level. Given that the prevalence of subnormal IGF1 levels in a GHD population is age-dependent, this would result in GH replacement being offered to more young adult onset (AO) GHD and childhood onset GHD adults, and less often to middle-aged and elderly AO GHD adults. This in itself has the added advantage that the skeletal benefits appear more real in the former cohort of patients.
    Citation
    Extensive expertise in endocrinology: UK stance on adult GH replacement: the economist vs the endocrinologist. 2013, 169 (4):R81-7 Eur J Endocrinol
    Journal
    European Journal of Endocrinology
    URI
    http://hdl.handle.net/10541/308837
    DOI
    10.1530/EJE-13-0418
    PubMed ID
    23904274
    Type
    Article
    Language
    en
    ISSN
    1479-683X
    ae974a485f413a2113503eed53cd6c53
    10.1530/EJE-13-0418
    Scopus Count
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