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Kreitschmann-Andermahr, Ilonka; Siegel, Sonja; Unger, Nicole; Streetz-van der Werf, Christine; Karges, Wolfram; Schilbach, Katharina; Schroeder, Bernadette; Szybowicz, Janine; Sauerwald, Janina; Zopf, Kathrin; Grzywotz, Agnieszka; Bidlingmaier, Martin; Sommer, Heide and Strasburger, Christian J. (2020): Motivation for and adherence to growth hormone replacement therapy in adults with hypopituitarism: the patients' perspective. In: Pituitary, Vol. 23, No. 5: pp. 479-487

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Introduction: While reasons for non-adherence in children requiring growth hormone (GH) replacement (GH-Rx) are well researched, few studies have investigated adherence in adult GH deficient patients. Against the Background: of the adverse medical sequelae of untreated severe GH deficiency (GHD) in adults, we explored adherence to GH-Rx and associated factors in this patient group. Method Cross-sectional analysis including 107 adult patients with severe GHD on GH-Rx, 15 untreated GDH patients and 19 who had discontinued therapy. Patients completed self-developed ad hoc surveys on adherence to medication and GH-Rx, specific beliefs about GH-Rx, side effects and burden of injection, reasons for never receiving or dropping out of therapy, respectively. Results Adherence to GH-Rx was high (mean 15.8/18 points on the self-developed adherence score) and significantly correlated with general medication adherence. Higher age was significantly associated with better adherence to GH-Rx, while injection side effects, duration of treatment or device used were not. The most frequent reasons for not being on GH-Rx apart from medical reasons included fear of side effects, lack of belief in treatment effects and dislike of injections. In patients not on GH-Rx, the proportion of patients in employment was significantly smaller than in the treatment group, despite similar age and comorbidities. Conclusions: Adherence to GH-Rx was high for those patients on therapy. Instead of focusing on improving adherence in those adults already on GH-Rx, efforts should be undertaken to ally fear of side effects and provide education on positive treatment effects for those eligible but not receiving therapy.

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