Is GH dosing optimal in female patients with adult‐onset GH deficiency? An analysis from the NordiNet ® International Outcome Study

Summary Objective To evaluate gender differences in GH dosing, IGF ‐I and cardiovascular risk markers in adults with GH deficiency ( GHD ). Design NordiNet ® International Outcome Study ( NCT 00960128), a noninterventional, multicentre study, evaluates the long‐term effectiveness and safety of Norditropin ® (Novo Nordisk A/S) in the real‐life clinical setting. Patients Nondiabetic patients ( n = 252; 41·7% female) with adult‐onset GHD (age ≥20 years at GH start), ≥4 years’ GH therapy and glycosylated haemoglobin (HbA 1c ) data at baseline and 4 years. Measurements Effects of gender (adjusted for baseline age and body mass index [ BMI ], average GH dose, treatment duration and concomitant medication) on change from baseline to 4 years (∆) in HbA 1c , fasting plasma glucose ( FPG ), IGF ‐I, lipids and waist circumference were evaluated. Results GH dose (mean [ SE ]; mg/day) was similar between females (0·22 [0·02]) and males (0·21 [0·01]) at baseline, but higher in females from year 1 (year 4, females, 0·45 [0·03]; males, 0·32 [0·02]). Mean IGF ‐I standard deviation score [ SDS ] was lower in females vs males at each treatment year; more than one‐third of females still had an IGF ‐I SDS below 0 at year 4, compared with only 21·8% of men. An adverse lipid profile at baseline remained poor in more females than males at 4 years. Improvement in total cholesterol was significantly associated with gender ( P < 0·0001), improving less in females than in males. Conclusions These data highlight that, even after 4 years, GH dose is suboptimal in many female patients, which may impact clinical outcomes; therefore, GH titration for women requires further improvement.