In order to evaluate the consequences of pituitary insufficiency on bone mineral status, bone min... more In order to evaluate the consequences of pituitary insufficiency on bone mineral status, bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry in 33 patients (aged 22-65 years) with pituitary insufficiency. BMD of the lumbar spine and femoral neck was decreased. Twenty of the patients were randomized to receive either recombinant human growth hormone (GH), 0.25 IU/kg/week for 6 months (0.125 IU/kg/week during the first month), or placebo. Serum osteocalcin levels increased significantly during GH administration. In the GH-treated group, there was no change in lumbar spine BMD and a small but significant decrease in femoral neck BMD (p < 0.05) after 6 months. Treatment periods longer than 6 months are needed to evaluate the potential beneficial effect of GH on BMD. This is in accordance with our previous findings of an increase in forearm BMD after 12 months of GH substitution therapy.
In the present study of twenty-two patients with Cushing&#39;s syndrome, serum insulin-like g... more In the present study of twenty-two patients with Cushing&#39;s syndrome, serum insulin-like growth factor (IGF)-I concentrations were normal to high with an increased mean IGF-I concentration, 40% above that of healthy subjects of the same age (p &lt; 0.001). Serum IGF-II concentrations were normal. The morning serum IGF binding protein (IGFBP)-1 concentrations were within the range of healthy controls. IGFBP-1 was inversely correlated to the IGF-I concentration (p &lt; 0.001) and to the 24 h urinary cortisol excretion (p &lt; 0.005) with a combined R squared value of 0.58. In contrast to IGFBP-1, serum IGFBP-2 and IGFBP-3 concentrations were elevated by 1.89 +/- 1.78 SD and 0.92 +/- 0.78 SD (mean +/- 2 SD), respectively. Although increased, the serum IGFBP-2 concentration was inversely correlated to the IGF-I concentration (r = -0.67, p &lt; 0.001). Immunoreactive IGFBP-3 was increased in proportion to IGF-I and the molar ratio [IGFBP-3]:[IGF-I] + [IGF-II] was close to unity (1.04 +/- 0.14), as that of healthy subjects. In serum from patients with Cushing&#39;s syndrome, with increased immunoreactive IGFBP-3, there was a corresponding increase in intact glycosylated 40-43 kDa IGFBP-3 as determined by Western ligand blotting. Neutral size chromatography of serum from patients with Cushing&#39;s syndrome showed that IGF-I and IGFBP-3 immunoreactivity were predominantly found at the elution volume of the ternary 150 kDa IGF-I/IGFBP-3/acid labile subunit complex and a similar pattern was displayed by normal serum.(ABSTRACT TRUNCATED AT 250 WORDS)
The risk of severe complications arising from primary hyperparathyroidism (pHPT) is increased dur... more The risk of severe complications arising from primary hyperparathyroidism (pHPT) is increased during pregnancy. Gestational pHPT often goes undiagnosed, and by the time it is diagnosed, a majority of women have endured one or more failed pregnancies. During pregnancy, active transport of calcium ions from the mother to the fetus leads to suppression of the fetal parathyroids. When the prenatal pool of calcium is depleted, the newborn may develop neonatal hypocalcemic tetany. The mother, in turn, may suffer from worsening hypercalcemia and a hypercalcemic crisis after delivery. Awareness and confirmation of the diagnosis may be crucial for the outcome. The only definitive treatment of pHPT is parathyroidectomy, which should be recommended in most cases. Our two cases illustrate both the importance of and the difficulty in detecting pHPT during pregnancy, as well as some of the serious complications that may occur during pregnancy and after delivery.
Journal of Clinical Endocrinology & Metabolism, 1996
The aim of the present trial was to study the individual responsiveness to GH treatment in terms ... more The aim of the present trial was to study the individual responsiveness to GH treatment in terms of body composition and to search for possible predictors of the response in GH-deficient adults. Sixty-eight patients (44 men and 24 women) with a mean age of 44.3 (1.2) yr and verified GH deficiency participated in a 2-phase treatment trial with an initial randomized, double blind, placebo-controlled, 6-month period, followed by an open treatment period, thereby ensuring all patients 12 months of GH treatment. Recombinant human GH was administered sc daily at bedtime, with a target dose of 12 micrograms/kg x day. GHBP was measured by ligand-mediated immunofunctional assay, and serum insulin-like growth factor I (IGF-I) was determined by RIA after acid-ethanol extraction, using a truncated IGF-I analog as the radioligand. Lean body mass (LBM) and body fat (BF) were determined by dual energy x-ray absorptiometry, and total body water (TBW) was determined by bioelectrical impedance. During the placebo control period, serum IGF-I,LBM, and TBW increased (P &amp;amp;lt; 0.001), whereas BF decreased (P &amp;amp;lt; 0.001) and serum GHBP was unchanged in the group treated with GH compared with the patients treated with placebo. After 12 months of GH treatment, the individual changes in BF ranged from -12.5 to 4.3 kg and from -4.5 to 10.1 kg in LBM. Age (P &amp;amp;lt; 0.05) and baseline GHBP level (P &amp;amp;lt; 0.01) were inversely correlated with the increase in LBM. The GH-induced increment in IGF-I and TBW was greater in men than in women (P &amp;amp;lt; 0.01), whereas the decreases in BF were similar in men and women. This trial demonstrates the variability in responsiveness to GH administration in GH-deficient adults. The best response to GH was obtained in younger patients with low GHBP levels. Furthermore, men responded better than women.
Adults with growth hormone deficiency (GHD) exhibit low bone mineral density (BMD) which improves... more Adults with growth hormone deficiency (GHD) exhibit low bone mineral density (BMD) which improves by growth hormone (GH) replacement therapy. The insulin-like growth factor (IGF) system has an established role in mediating the effects of GH on bone and IGF binding proteins (IGFBP)-4 and IGFBP-5 have been shown to modulate the effects of IGFs in bone. Therefore, we studied serum levels of IGFBP-4 and IGFBP-5 and their relationship to serum levels of bone biochemical markers and BMD in adults with GH deficiency (GHD) before and during GH therapy. Serum levels of IGFBP-5 and IGFBP-4 were measured on samples from 20 patients (11 males) 22-57 years of age. All had IGF-I serum values below -2 standard deviation score. The first 6 months were placebo controlled and all received 3 years of active treatment with the mean dose 0.23 +/- 0.01 IU/kg/week divided into daily subcutaneous injections. Serum IGFBP-5 levels in GHD adults were low at baseline and positively related to total body, femoral neck, trochanter, and Ward&amp;amp;amp;amp;#39;s triangle BMD (r = 0.471, 0.549, 0.462, and 0.470, respectively, p &amp;amp;amp;amp;lt; 0.05). The mean serum IGFBP-5 level increased by about 2-fold within 3 months after the initiation of GH therapy and was correlated with serum IGF-I (r = 0.719, 0.801, and 0.722 before and after 18 and 36 months, respectively,p &amp;amp;amp;amp;lt; 0.001). A positive correlation between serum IGFBP-5 levels and lumbar spine BMD was found during GH treatment but not before. The percentage increase of serum IGFBP-5 after GH therapy showed a positive correlation with the percentage increase of total alkaline phosphate activity (r = 0.347 p &amp;amp;amp;amp;lt; 0.05). In contrast to IGFBP-5, serum IGFBP-4 levels were positively related to body mass index (r = 0.607, p &amp;amp;amp;amp;lt; 0.01). Baseline serum IGFBP-4 levels also correlated with total body, femoral neck, trochanter, and Ward&amp;amp;amp;amp;#39;s triangle BMD (r = 0.502, 0.590, 0.612, and 0.471, respectively,p &amp;amp;amp;amp;lt; 0.05). The mean serum IGFBP-4 level was increased by 25% within 3 months after initiation of GH therapy and did not correlate with serum IGF-I levels. Although the above findings are consistent with the idea that GH-induced changes in serum IGFBP-5 and IGFBP-4 levels may in part mediate the anabolic effects of GH on bone tissue in adults with GHD, further studies are needed to establish the cause and effect relationship.
Gamma radiation from 60Co delivered with stereotactic technique was given to the pituitary gland ... more Gamma radiation from 60Co delivered with stereotactic technique was given to the pituitary gland in 35 patients, aged 18-65 years, with Cushing&#39;s disease. The doses were 70-100 Gy in each single irradiation. The size of the sella turcica was normal in the majority of the patients. The observation time was 3-9 years in 29 patients. Out of them, 14 (48%) obtained clinical remission and normal urinary cortisol after one irradiation. Eight achieved remission after two to four irradiations. In total, 22 out of 29 patients (76%) obtained remission. In 12 of them remission was obtained in 1 year and in another 10 within 3 years. No recurrences were observed. Improvement was seen in 2 patients after one and three irradiations. Bilateral adrenalectomy was performed in 5 patients owing to unsatisfactory effect of irradiation. Pituitary insufficiency with gonadotropin, thyrotropin or corticotropin failure was demonstrated in 12 of 22 patients in remission. This occurred 4 months to 7 years after the first irradiation. Another 6 patients were followed less than 3 years after the first irradiation. Two obtained remission after the first treatment, whereas the other 4 improved. Stereotactic pituitary irradiation is suggested as a non-invasive therapeutic alternative in Cushing&#39;s disease for example in patients with considerable surgical risk or as a supplement to pituitary microsurgery.
In a double-blind cross-over study with recombinant methionyl growth hormone (GH) and placebo dur... more In a double-blind cross-over study with recombinant methionyl growth hormone (GH) and placebo during 12 weeks, the effect of GH substitution therapy (0.5-06 IU.kg-1.week-1) on physical performance, muscle strength, bone mineral density, and mood and cognitive functions was investigated in 6 GH-deficient adults. During GH substitution serum concentrations of insulin-like growth factor-I and procollagen-III peptide increased in all 6 patients, whereas concentrations of serum urea decreased. Five of the patients identified the GH period and reported improved well-being with increased mental alertness and vitality and improved physical capacity and muscle strength. There was, however, no change of the isokinetic muscle strength during GH substitution therapy, and the working capacity on the bicycle ergometer was just slightly improved in some patients. The bone mineral density was low and unchanged in all patients. Mood and cognitive functions did not change during GH therapy. A reversible fluid retention was observed in one patient during the GH period. In conclusion, short-term GH substitution therapy to GH-deficient adults induced a subjective improvement of general well-being. Longer treatment periods will be necessary to establish the effect on physical capacity, muscle strength, bone mineral density, and mood and cognitive functions.
... G H DEFICIENCY in adults is associated with impaired psychological well-being, abnormal body ... more ... G H DEFICIENCY in adults is associated with impaired psychological well-being, abnormal body composi-tion, metabolic abnormalities (l), and increased cardiovas-cular mortality (2). Several of these ... Several factors, such as gender, age, and whether the GH deficiency ...
The aim of this study was to evaluate patients&amp;amp;#39; perception and acceptance of a ne... more The aim of this study was to evaluate patients&amp;amp;#39; perception and acceptance of a new multi-dose injection device (Genotropin Pen) for recombinant growth hormone (GH) supplied in a two-chamber cartridge. The pen is combined with a very thin needle (B-D Microfine + (29 G) and meets future demands when dosing of GH will be changed from International Units (IU) to milligrams (mg). A total of 39 children receiving GH treatment (East Hospital, Gothenburg and St Bartholomew&amp;amp;#39;s Hospital, London), aged between 7 and 17 years, and 39 GH-treated adults (Sahlgrenska Hospital, Gothenburg and Karolinska Hospital, Stockholm), aged between 20 and 68 years, participated in the study. The daily dose ranged from 0.3 mg to 2.6 mg. The injections were given subcutaneously, once daily, and most of the patients used the thigh as an injection site. After a trial period of 2 weeks, injection technique, pain, fear of injection and convenience of the Genotropin Pen were compared with the experience with the prestudy device (Genotropin KabiPen 16, 16(8) or 36) by questionnaire. A total of 95% of the patients preferred the Genotropin Pen to the prestudy device for the following reasons: a greater certainty of correct dosing with the digital display; the possibility of correcting the set dose; the lock function of the injection button when injection is complete; more comfortable to hold due to the design and the plastic material; and reduced pain when injecting due to the thinner needles. Four patients (5%) preferred the prestudy device KabiPen as they considered this to be &amp;amp;#39;good enough&amp;amp;#39;. Thus, the Genotropin Pen is a convenient injection device and most patients prefer it to the KabiPen.
The effects of a 12-week period of substitution therapy with somatrem have been investigated in s... more The effects of a 12-week period of substitution therapy with somatrem have been investigated in six adults with confirmed hGH deficiency. Five of the six patients experienced a subjective improvement, mentally and physically, but these improvements were not demonstrated when the patients were assessed objectively. No side-effects were reported. Serum procollagen III peptide increased in all patients and serum IGF-1 increased in five of the six patients.
In order to evaluate the consequences of pituitary insufficiency on bone mineral status, bone min... more In order to evaluate the consequences of pituitary insufficiency on bone mineral status, bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry in 33 patients (aged 22-65 years) with pituitary insufficiency. BMD of the lumbar spine and femoral neck was decreased. Twenty of the patients were randomized to receive either recombinant human growth hormone (GH), 0.25 IU/kg/week for 6 months (0.125 IU/kg/week during the first month), or placebo. Serum osteocalcin levels increased significantly during GH administration. In the GH-treated group, there was no change in lumbar spine BMD and a small but significant decrease in femoral neck BMD (p < 0.05) after 6 months. Treatment periods longer than 6 months are needed to evaluate the potential beneficial effect of GH on BMD. This is in accordance with our previous findings of an increase in forearm BMD after 12 months of GH substitution therapy.
In the present study of twenty-two patients with Cushing&#39;s syndrome, serum insulin-like g... more In the present study of twenty-two patients with Cushing&#39;s syndrome, serum insulin-like growth factor (IGF)-I concentrations were normal to high with an increased mean IGF-I concentration, 40% above that of healthy subjects of the same age (p &lt; 0.001). Serum IGF-II concentrations were normal. The morning serum IGF binding protein (IGFBP)-1 concentrations were within the range of healthy controls. IGFBP-1 was inversely correlated to the IGF-I concentration (p &lt; 0.001) and to the 24 h urinary cortisol excretion (p &lt; 0.005) with a combined R squared value of 0.58. In contrast to IGFBP-1, serum IGFBP-2 and IGFBP-3 concentrations were elevated by 1.89 +/- 1.78 SD and 0.92 +/- 0.78 SD (mean +/- 2 SD), respectively. Although increased, the serum IGFBP-2 concentration was inversely correlated to the IGF-I concentration (r = -0.67, p &lt; 0.001). Immunoreactive IGFBP-3 was increased in proportion to IGF-I and the molar ratio [IGFBP-3]:[IGF-I] + [IGF-II] was close to unity (1.04 +/- 0.14), as that of healthy subjects. In serum from patients with Cushing&#39;s syndrome, with increased immunoreactive IGFBP-3, there was a corresponding increase in intact glycosylated 40-43 kDa IGFBP-3 as determined by Western ligand blotting. Neutral size chromatography of serum from patients with Cushing&#39;s syndrome showed that IGF-I and IGFBP-3 immunoreactivity were predominantly found at the elution volume of the ternary 150 kDa IGF-I/IGFBP-3/acid labile subunit complex and a similar pattern was displayed by normal serum.(ABSTRACT TRUNCATED AT 250 WORDS)
The risk of severe complications arising from primary hyperparathyroidism (pHPT) is increased dur... more The risk of severe complications arising from primary hyperparathyroidism (pHPT) is increased during pregnancy. Gestational pHPT often goes undiagnosed, and by the time it is diagnosed, a majority of women have endured one or more failed pregnancies. During pregnancy, active transport of calcium ions from the mother to the fetus leads to suppression of the fetal parathyroids. When the prenatal pool of calcium is depleted, the newborn may develop neonatal hypocalcemic tetany. The mother, in turn, may suffer from worsening hypercalcemia and a hypercalcemic crisis after delivery. Awareness and confirmation of the diagnosis may be crucial for the outcome. The only definitive treatment of pHPT is parathyroidectomy, which should be recommended in most cases. Our two cases illustrate both the importance of and the difficulty in detecting pHPT during pregnancy, as well as some of the serious complications that may occur during pregnancy and after delivery.
Journal of Clinical Endocrinology & Metabolism, 1996
The aim of the present trial was to study the individual responsiveness to GH treatment in terms ... more The aim of the present trial was to study the individual responsiveness to GH treatment in terms of body composition and to search for possible predictors of the response in GH-deficient adults. Sixty-eight patients (44 men and 24 women) with a mean age of 44.3 (1.2) yr and verified GH deficiency participated in a 2-phase treatment trial with an initial randomized, double blind, placebo-controlled, 6-month period, followed by an open treatment period, thereby ensuring all patients 12 months of GH treatment. Recombinant human GH was administered sc daily at bedtime, with a target dose of 12 micrograms/kg x day. GHBP was measured by ligand-mediated immunofunctional assay, and serum insulin-like growth factor I (IGF-I) was determined by RIA after acid-ethanol extraction, using a truncated IGF-I analog as the radioligand. Lean body mass (LBM) and body fat (BF) were determined by dual energy x-ray absorptiometry, and total body water (TBW) was determined by bioelectrical impedance. During the placebo control period, serum IGF-I,LBM, and TBW increased (P &amp;amp;lt; 0.001), whereas BF decreased (P &amp;amp;lt; 0.001) and serum GHBP was unchanged in the group treated with GH compared with the patients treated with placebo. After 12 months of GH treatment, the individual changes in BF ranged from -12.5 to 4.3 kg and from -4.5 to 10.1 kg in LBM. Age (P &amp;amp;lt; 0.05) and baseline GHBP level (P &amp;amp;lt; 0.01) were inversely correlated with the increase in LBM. The GH-induced increment in IGF-I and TBW was greater in men than in women (P &amp;amp;lt; 0.01), whereas the decreases in BF were similar in men and women. This trial demonstrates the variability in responsiveness to GH administration in GH-deficient adults. The best response to GH was obtained in younger patients with low GHBP levels. Furthermore, men responded better than women.
Adults with growth hormone deficiency (GHD) exhibit low bone mineral density (BMD) which improves... more Adults with growth hormone deficiency (GHD) exhibit low bone mineral density (BMD) which improves by growth hormone (GH) replacement therapy. The insulin-like growth factor (IGF) system has an established role in mediating the effects of GH on bone and IGF binding proteins (IGFBP)-4 and IGFBP-5 have been shown to modulate the effects of IGFs in bone. Therefore, we studied serum levels of IGFBP-4 and IGFBP-5 and their relationship to serum levels of bone biochemical markers and BMD in adults with GH deficiency (GHD) before and during GH therapy. Serum levels of IGFBP-5 and IGFBP-4 were measured on samples from 20 patients (11 males) 22-57 years of age. All had IGF-I serum values below -2 standard deviation score. The first 6 months were placebo controlled and all received 3 years of active treatment with the mean dose 0.23 +/- 0.01 IU/kg/week divided into daily subcutaneous injections. Serum IGFBP-5 levels in GHD adults were low at baseline and positively related to total body, femoral neck, trochanter, and Ward&amp;amp;amp;amp;#39;s triangle BMD (r = 0.471, 0.549, 0.462, and 0.470, respectively, p &amp;amp;amp;amp;lt; 0.05). The mean serum IGFBP-5 level increased by about 2-fold within 3 months after the initiation of GH therapy and was correlated with serum IGF-I (r = 0.719, 0.801, and 0.722 before and after 18 and 36 months, respectively,p &amp;amp;amp;amp;lt; 0.001). A positive correlation between serum IGFBP-5 levels and lumbar spine BMD was found during GH treatment but not before. The percentage increase of serum IGFBP-5 after GH therapy showed a positive correlation with the percentage increase of total alkaline phosphate activity (r = 0.347 p &amp;amp;amp;amp;lt; 0.05). In contrast to IGFBP-5, serum IGFBP-4 levels were positively related to body mass index (r = 0.607, p &amp;amp;amp;amp;lt; 0.01). Baseline serum IGFBP-4 levels also correlated with total body, femoral neck, trochanter, and Ward&amp;amp;amp;amp;#39;s triangle BMD (r = 0.502, 0.590, 0.612, and 0.471, respectively,p &amp;amp;amp;amp;lt; 0.05). The mean serum IGFBP-4 level was increased by 25% within 3 months after initiation of GH therapy and did not correlate with serum IGF-I levels. Although the above findings are consistent with the idea that GH-induced changes in serum IGFBP-5 and IGFBP-4 levels may in part mediate the anabolic effects of GH on bone tissue in adults with GHD, further studies are needed to establish the cause and effect relationship.
Gamma radiation from 60Co delivered with stereotactic technique was given to the pituitary gland ... more Gamma radiation from 60Co delivered with stereotactic technique was given to the pituitary gland in 35 patients, aged 18-65 years, with Cushing&#39;s disease. The doses were 70-100 Gy in each single irradiation. The size of the sella turcica was normal in the majority of the patients. The observation time was 3-9 years in 29 patients. Out of them, 14 (48%) obtained clinical remission and normal urinary cortisol after one irradiation. Eight achieved remission after two to four irradiations. In total, 22 out of 29 patients (76%) obtained remission. In 12 of them remission was obtained in 1 year and in another 10 within 3 years. No recurrences were observed. Improvement was seen in 2 patients after one and three irradiations. Bilateral adrenalectomy was performed in 5 patients owing to unsatisfactory effect of irradiation. Pituitary insufficiency with gonadotropin, thyrotropin or corticotropin failure was demonstrated in 12 of 22 patients in remission. This occurred 4 months to 7 years after the first irradiation. Another 6 patients were followed less than 3 years after the first irradiation. Two obtained remission after the first treatment, whereas the other 4 improved. Stereotactic pituitary irradiation is suggested as a non-invasive therapeutic alternative in Cushing&#39;s disease for example in patients with considerable surgical risk or as a supplement to pituitary microsurgery.
In a double-blind cross-over study with recombinant methionyl growth hormone (GH) and placebo dur... more In a double-blind cross-over study with recombinant methionyl growth hormone (GH) and placebo during 12 weeks, the effect of GH substitution therapy (0.5-06 IU.kg-1.week-1) on physical performance, muscle strength, bone mineral density, and mood and cognitive functions was investigated in 6 GH-deficient adults. During GH substitution serum concentrations of insulin-like growth factor-I and procollagen-III peptide increased in all 6 patients, whereas concentrations of serum urea decreased. Five of the patients identified the GH period and reported improved well-being with increased mental alertness and vitality and improved physical capacity and muscle strength. There was, however, no change of the isokinetic muscle strength during GH substitution therapy, and the working capacity on the bicycle ergometer was just slightly improved in some patients. The bone mineral density was low and unchanged in all patients. Mood and cognitive functions did not change during GH therapy. A reversible fluid retention was observed in one patient during the GH period. In conclusion, short-term GH substitution therapy to GH-deficient adults induced a subjective improvement of general well-being. Longer treatment periods will be necessary to establish the effect on physical capacity, muscle strength, bone mineral density, and mood and cognitive functions.
... G H DEFICIENCY in adults is associated with impaired psychological well-being, abnormal body ... more ... G H DEFICIENCY in adults is associated with impaired psychological well-being, abnormal body composi-tion, metabolic abnormalities (l), and increased cardiovas-cular mortality (2). Several of these ... Several factors, such as gender, age, and whether the GH deficiency ...
The aim of this study was to evaluate patients&amp;amp;#39; perception and acceptance of a ne... more The aim of this study was to evaluate patients&amp;amp;#39; perception and acceptance of a new multi-dose injection device (Genotropin Pen) for recombinant growth hormone (GH) supplied in a two-chamber cartridge. The pen is combined with a very thin needle (B-D Microfine + (29 G) and meets future demands when dosing of GH will be changed from International Units (IU) to milligrams (mg). A total of 39 children receiving GH treatment (East Hospital, Gothenburg and St Bartholomew&amp;amp;#39;s Hospital, London), aged between 7 and 17 years, and 39 GH-treated adults (Sahlgrenska Hospital, Gothenburg and Karolinska Hospital, Stockholm), aged between 20 and 68 years, participated in the study. The daily dose ranged from 0.3 mg to 2.6 mg. The injections were given subcutaneously, once daily, and most of the patients used the thigh as an injection site. After a trial period of 2 weeks, injection technique, pain, fear of injection and convenience of the Genotropin Pen were compared with the experience with the prestudy device (Genotropin KabiPen 16, 16(8) or 36) by questionnaire. A total of 95% of the patients preferred the Genotropin Pen to the prestudy device for the following reasons: a greater certainty of correct dosing with the digital display; the possibility of correcting the set dose; the lock function of the injection button when injection is complete; more comfortable to hold due to the design and the plastic material; and reduced pain when injecting due to the thinner needles. Four patients (5%) preferred the prestudy device KabiPen as they considered this to be &amp;amp;#39;good enough&amp;amp;#39;. Thus, the Genotropin Pen is a convenient injection device and most patients prefer it to the KabiPen.
The effects of a 12-week period of substitution therapy with somatrem have been investigated in s... more The effects of a 12-week period of substitution therapy with somatrem have been investigated in six adults with confirmed hGH deficiency. Five of the six patients experienced a subjective improvement, mentally and physically, but these improvements were not demonstrated when the patients were assessed objectively. No side-effects were reported. Serum procollagen III peptide increased in all patients and serum IGF-1 increased in five of the six patients.
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Papers by M. Degerblad