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dc.contributor.authorShalet, Stephen M
dc.date.accessioned2013-12-20T11:35:24Z
dc.date.available2013-12-20T11:35:24Z
dc.date.issued2013-10
dc.identifier.citationExtensive expertise in endocrinology: UK stance on adult GH replacement: the economist vs the endocrinologist. 2013, 169 (4):R81-7 Eur J Endocrinolen
dc.identifier.issn1479-683X
dc.identifier.pmid23904274
dc.identifier.doi10.1530/EJE-13-0418
dc.identifier.urihttp://hdl.handle.net/10541/308837
dc.description.abstractIn 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.
dc.language.isoenen
dc.rightsArchived with thanks to European journal of endocrinology / European Federation of Endocrine Societiesen
dc.subject.meshAdult
dc.subject.meshDwarfism, Pituitary
dc.subject.meshEndocrinology
dc.subject.meshGreat Britain
dc.subject.meshHuman Growth Hormone
dc.subject.meshHumans
dc.subject.meshHypopituitarism
dc.subject.meshModels, Econometric
dc.subject.meshPrevalence
dc.titleExtensive expertise in endocrinology: UK stance on adult GH replacement: the economist vs the endocrinologist.en
dc.typeArticleen
dc.contributor.departmentDepartment of Endocrinology, Christie Hospital NHS Trust, Wilmslow Road, Manchester M20 4BX, UK.en
dc.identifier.journalEuropean Journal of Endocrinologyen
html.description.abstractIn 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.


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