A Prospective Study of 5 Years of GH Replacement Therapy in GH-Deficient Adults: Sustained Effects on Body Composition, Bone Mass, and Metabolic Indices

Abstract

GH replacement therapy has proved its efficacy and safety in short-term trials and in a few long-term trials with limited number of subjects. In this 1-center study, including 118 consecutive adults (70 men and 48 women; mean age, 49.3 yr; range, 22-74 yr) with adult-onset GH deficiency, the effects of 5 yr of GH replacement on body composition, bone mass, and metabolic indices were determined. The mean initial GH dose was 0.98 mg/d. The dose was gradually lowered, and after 5 yr the mean dose was 0.48 mg/d. The mean IGF-I SD score increased from -1.73 at baseline to 1.66 at study end. A sustained increase in lean body mass and a decrease in body fat were observed. The GH treatment increased total body bone mineral content as well as lumbar (L2-L4) and femur neck bone mineral contents. BMD in lumbar spine (L2-L4) and femur neck were increased and normalized at study end. Total cholesterol and low density lipoprotein cholesterol decreased, and high density lipoprotein cholesterol increased. At 5 yr, serum concentrations of triglycerides and hemoglobin A(1c) were reduced compared with baseline values. The treatment responses in IGF-I SD score, body fat as estimated by four- and five-compartment body composition models, total body protein and nitrogen, and lumbar bone mineral content and BMD were more marked in men than in women. One patient died during the period, four patients discontinued the study due to adverse events, and one dropped out due to lack of compliance. Four patients were lost to follow-up. However, all patients were retained in the statistical analysis according to the intention to treat approach used. In conclusion, 5 yr of GH substitution in GH-deficient adults is safe and well tolerated. The effects on body composition, bone mass, and metabolic indices were sustained. The effects on body composition and low density lipoprotein cholesterol were seen after 1 yr, whereas the effects on bone mass, triglycerides, and hemoglobin A(1c) were first observed after years of treatment.

Growth Hormone (GH) Effects on Central Fat Accumulation in Adult Japanese GH Deficient Patients: 6-month Fixed-dose Effects Persist during Second 6-month Individualized-dose Phase

“…While this is in keeping with the literature [21], this study additionally showed that in the Japanese patients the loss of FM specifically affects the trunk. The decrease in percent trunk fat mass at 48 weeks would correspond to an average loss of about 1.0 kg in abdominal FM.…”

Prevalence of Pituitary Hormone Dysfunction, Metabolic Syndrome, and Impaired Quality of Life in Retired Professional Football Players: A Prospective Study

“…[49][50][51][52][53][54][55][56][57][58][59][60] In addition to poor QoL, both GHD and hypogonadism can contribute to decreased lean body mass, increased fat mass (in particular, visceral fat), and poor exercise capacity that further contribute to poor QoL, obesity, and MetS, increasing cardiovascular disease (CVD) risk. 51,54,57,[61][62][63][64][65][66][67][68][69][70] Studies have shown that MetS is associated with, and predicts the development of, low serum testosterone levels in men. 62,64,65,71 Five of 6 subjects with hypogonadism had MetS and obesity.…”

Deficiência de GH em adultos: resultados do estudo multicêntrico brasileiro

“…O GH estimula a hidroxilação renal da 25-OH vit D3, absorção renal de cálcio e tem efeitos renais de retenção de fosfato (2,43). Outro provável mecanismo de ação do GH é através de aumento na carga mecânica imposta aos ossos, visto que o GH leva a maior massa e força muscular (5,44). Uma correlação entre DMO e secreção de GH em adultos jovens saudáveis já foi descrita (45), bem como correlação entre níveis baixos de IGF-1 e risco de fraturas osteoporóticas em mulheres saudáveis pós-menopausa (46).…”

“…Estudos com uso de GH a longo prazo (pelo menos 18-24 meses) mostram aumento na DMO, mas ainda não se sabe se isso se traduz em uma redução no risco de fraturas (5,(49)(50)(51)(52)(53)(54). Encontramos aumento da DMO de coluna lombar e fêmur após 12 meses de reposição de GH (1,99±4,27% em coluna lombar e 2,55±4,30% no fêmur), que se manteve após 24 meses de tratamento (2,31±7,17% em coluna lombar e 5,33±9,64% no fêmur).…”

“…Atualmente, a deficiência de GH em adultos é considerada uma síndrome clínica bem definida, existindo já alguns relatos de reposição de GH a longo prazo (4,5). Gibney e cols.…”