Suicides in National Hormone Pituitary Program Recipients of Cadaver-Derived Human Growth Hormone

Joseph Y Abrams; James L Mills; Lawrence B Schonberger; David Chang; Ryan A Maddox; Ermias D Belay; Ellen W Leschek

doi:10.1210/jendso/bvad130

Suicides in National Hormone Pituitary Program Recipients of Cadaver-Derived Human Growth Hormone

J Endocr Soc. 2023 Oct 31;7(12):bvad130. doi: 10.1210/jendso/bvad130. eCollection 2023 Nov 2.

Authors

Joseph Y Abrams¹, James L Mills², Lawrence B Schonberger¹, David Chang³, Ryan A Maddox¹, Ermias D Belay¹, Ellen W Leschek⁴

Affiliations

¹ Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
² Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA.
³ Westat, Rockville, MD 20850, USA.
⁴ National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA.

Abstract

Context: Numerous reports of suicide among individuals who received cadaver-derived human growth hormone (c-hGH) through the National Hormone Pituitary Program (NHPP) raised the alarm for potentially increased suicide risk.

Objective: We conducted a study to assess suicide risk in the NHPP cohort and identify contributing factors to facilitate early recognition and intervention.

Methods: The study population consisted of patients receiving NHPP c-hGH starting from 1957, and cohort deaths with an ICD code consistent with suicide or possible suicide through 2020 were evaluated. Descriptive data were extracted from medical records. Standardized mortality ratios (SMRs) to compare the observed number of suicide deaths in the cohort to the expected number were calculated using general population suicide rates by sex, age group, and time period.

Results: Among 6272 patients there were 1200 all-cause cohort deaths, of which 55 (52 male, 3 female) were attributed to suicide. Of these, 47 were identified by ICD code alone compared to an expected count of 37.8 (SMR = 1.25, 95% CI 0.91-1.66). Among male cohort members, the SMR was 1.33 (95% CI 0.97-1.78). Elevated risk of suicide was detected for cohort members aged 25-34 (SMR = 1.79, 95% CI 1.06-2.83) and during the period from September 19, 1985, to December 31, 1998 (SMR = 1.70, 95% CI 1.02-2.65).

Conclusion: Overall, the observed number of suicides among NHPP c-hGH recipients was not significantly higher than expected. However, certain subgroups may be at elevated risk of suicide. Studies are needed to better understand the nature and magnitude of suicide risk among c-hGH recipients to facilitate early intervention to prevent suicide deaths.

Keywords: US cohort study; human growth hormone; pituitary growth hormone; short stature; suicide.

Published by Oxford University Press on behalf of the Endocrine Society 2023.