Discontinued Treatment for GHD Linked to Alzheimer’s Disease

On Monday, January 29, 2024, researchers from the United Kingdom published an article in Nature Medicine identifying iatrogenic Alzheimer’s disease in individuals who were treated with cadaveric pituitary-derived growth hormone to manage growth hormone deficiency (GHD).

Until this point, Alzheimer’s disease had been characterized exclusively as a sporadic disease with early- and late-onset conditions. However, this discovery proved that specific medical interventions could perpetuate the condition.

The study evaluated eight participants who had been treated with human growth hormone derived from the pituitary gland of a cadaver for growth hormone deficiency. Three participants were deceased at the time of the study, dying at ages 47, 54, and 57.

Among the five participants who experienced symptoms of early-onset dementia, four of them had symptom onset between 38 and 49 years old, with the final patient first experiencing symptoms at 55.

Three of the patients with dementia symptoms were diagnosed with Alzheimer's disease before the start of the study. However, the researchers note that the remaining two patients with no official diagnosis met the requirements for probable Alzheimer’s based on the UK National Institute on Aging and Alzheimer’s Association (NIA-AA) diagnostic criteria. Additionally, the researchers note that all patients met the requirements listed in the Diagnostic and Statistical Manual of Mental Disorders-V (DSM-V).

Although the remaining three patients did not have early-onset dementia, one was characterized as having mild cognitive impairment, and another had subjective cognitive symptoms. The remaining patient did not have any symptoms.

Considering the young age of the disease or symptom onset, the researchers theorized that these Alzheimer’s cases were not sporadic. This theory was supported by genetic testing data on five patients that revealed there was no risk of inherited Alzheimer's disease.

Based on this data, the researchers concluded that these patients may have iatrogenic Alzheimer’s disease caused by cadaveric pituitary-derived growth hormone use to manage GHD. While cadaveric pituitary-derived growth hormone treatments were discontinued in the 1980s, understanding how it impacted transmission may help guide future treatment protocols.

“The recognition of transmission of amyloid-beta pathology in these rare situations should lead us to review measures to prevent accidental transmission via other medical or surgical procedures in order to prevent such cases occurring in future,” concluded Professor John Collinge, Director of the University College London (UCL) Institute of Prion Diseases and a consultant neurologist at UCL Hospital in the press release. “Importantly, our findings also suggest that Alzheimer's and some other neurological conditions share similar disease processes to CJD, and this may have important implications for understanding and treating Alzheimer’s disease in the future.”