A Reappraisal of Diagnosing GH Deficiency in Adults: Role of Gender, Age, Waist Circumference, and Body Mass Index

Colao, Annamaria; Somma, Carolina Di; Savastano, Silvia; Rota, Francesca Silvia; Savanelli, Maria Cristina; Aimaretti, Gianluca; Lombardi, Gaetano

doi:10.1210/jc.2009-1134

Cited by 60 publications

(54 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our data confirmed the mutual relationship between GHD and adiposity, since a strong negative correlation was found between VAI and GH peak at diagnosis, in agreement with previous studies that demonstrated that GH peak after GHRH plus arginine depends more on WC than on BMI [39]. Ideally, the possibility to use one single value representingat the same time BMI and WC could be very useful, and in this light the VAI might represent a useful tool.…”

Section: Discussionsupporting

confidence: 91%

The visceral adiposity index is associated with insulin sensitivity and IGF-I levels in adults with growth hormone deficiency

2016

View full text Add to dashboard Cite

The visceral adiposity index, based on anthropometric and metabolic parameters, has been shown to be related to adipose tissue function and insulin sensitivity. We aimed to evaluate the performance of the visceral adiposity index in adult patients with growth hormone deficiency. We enrolled 52 patients(mean age 51 ± 13 years) with newly diagnosed growth hormone deficiency and 50 matched healthy subjects as controls at baseline. At baseline and after 12 and 24 months of treatment we evaluated anthropometric measures, lipid profile, glucose and insulin during an oral glucose tolerance test, hemoglobin A1c, homeostasis model assessment estimate of insulin resistance, quantitative insulin sensitivity check index, insulin sensitivity index Matsuda, insulin-like growth factor-I and visceral adiposity index. At baseline growth hormone deficiency patients showed higher waist circumference (p < 0.001), low-density lipoprotein cholesterol (p < 0.001) and visceral adiposity index (p = 0.003) with lower insulin sensitivity index (p = 0.007) and high-density lipoprotein cholesterol (p = 0.001) than controls. During growth hormone treatment we observed a significant increase in insulin-like growth factor-I (p < 0.001), high-density lipoprotein (p < 0.001) with a trend toward increase in insulin sensitivity index (p = 0.055) and a significant decrease in total cholesterol (p < 0.001) and visceral adiposity index (p < 0.001), while no significant changes were observed in other clinical and metabolic parameters. The visceral adiposity index was the only parameter that significantly correlated with growth hormone peak at diagnosis (p < 0.001) and with insulin-like growth factor-I and insulin sensitivity index both at diagnosis (p = 0.009 and p < 0.001) and after 12 (p = 0.026 and p = 0.001) and 24 months (p < 0.001 and p = 0.001) of treatment. The visceral adiposity index, which has shown to be associated with both insulin-like growth factor-I and insulin sensitivity, proved to be the most reliable index of metabolic perturbation, among the most common indexes of adiposity assessment and a marker of benefit during treatment in adult growth hormone deficiency patients.

show abstract

Section: Discussionsupporting

confidence: 91%

The visceral adiposity index is associated with insulin sensitivity and IGF-I levels in adults with growth hormone deficiency

2016

View full text Add to dashboard Cite

show abstract

“…While the influence of a pathological GH axis on lipid levels was analyzed in numerous clinical studies (10,14,16,17,18,19,20,21,22,23,33,34,35), observational studies in general population samples are scarce and longitudinal analysis is missing. To the best of our knowledge, the present study is the largest populationbased study using an IGF1 and IGFBP3 measurement in line with recommendation of the Keswick consensus conference to close this gap.…”

Section: Discussionmentioning

confidence: 99%

“…The older age of these subjects might be a reason for the conflicting results and further a limiting factor for a general conclusion. With respect to patient studies, low and high IGF1 levels outside the reference range are associated with lower HDL cholesterol (10,14,19,20,21,23,33). An interesting observation was made among GHD patients who discontinued their GH replacement therapy.…”

Section: European Journal Of Endocrinologymentioning

confidence: 99%

Cross-sectional and longitudinal relation of IGF1 and IGF-binding protein 3 with lipid metabolism

Eggert

Wallaschofski

Grotevendt

et al. 2014

European Journal of Endocrinology

View full text Add to dashboard Cite

Background: Previous intervention studies in patients with GH disorders suggested an impact of IGF1 and IGF-binding protein 3 (IGFBP3) on lipid metabolism, whereas population-based studies revealed conflicting results. Therefore, we aimed to assess the cross-sectional and longitudinal associations between IGF1 or IGFBP3 serum levels and lipids (total, LDL, or HDL cholesterol and triglycerides) in a large-scale study. Methods: Data of 2935 subjects (1356 women) from the population-based Study of Health in Pomerania (SHIP) were used. ANOVA, quantile regression, and logistic regression models adjusted for age, waist circumference, physical activity, and alcohol consumption were performed. Results: In cross-sectional analyses, we detected that IGF1 and IGFBP3 levels were positively related to total and LDL cholesterol and inversely related to HDL cholesterol in both sexes. Furthermore, IGFBP3 levels showed a positive relationship to triglycerides. In total, IGFBP3 levels were more strongly associated to lipids than IGF1. In longitudinal analysis, we found no influence of baseline IGF1 or IGFBP3 serum concentration on incidentally elevated or reduced lipid levels. However, the positive relationship between IGFBP3 and incidentally elevated triglycerides barely missed statistical significance in women. Conclusion: The present study showed strong cross-sectional associations between IGF1 or IGFBP3 and lipids, whereas no longitudinal relationships were revealed. Therefore, our findings suggest IGF1 and IGFBP3 as a risk marker rather than a risk factor for alterations in lipid metabolism. Further studies are needed to elucidate the mechanisms underlying the association between the GH/IGF axis and lipid metabolism.

show abstract

“…If BMI-adjusted cutoff values are not used, a higher proportion of patients will be classified as GHD. In addition, age-adjusted cutoff values have recently been reported for the GHRH-arginine test (31).…”

Section: Discussionmentioning

confidence: 99%

Low prevalence of hypopituitarism after traumatic brain injury: a multicenter study

Kokshoorn

Smit

Nieuwlaat

et al. 2011

European Journal of Endocrinology

View full text Add to dashboard Cite

Objective: Hypopituitarism after traumatic brain injury (TBI) is considered to be a prevalent condition. However, prevalence rates differ considerably among reported studies, due to differences in definitions, endocrine assessments of hypopituitarism, and confounding factors, such as timing of evaluation and the severity of the trauma. Aim: To evaluate the prevalence of hypopituitarism in a large cohort of TBI patients after long-term follow-up using a standardized endocrine evaluation. Study design: Cross-sectional study. Patients and methods:We included 112 patients with TBI, hospitalized for at least 3 days and duration of follow-up O1 year after TBI from five (neurosurgical) referral centers. Evaluation of pituitary function included fasting morning hormone measurements and insulin tolerance test (nZ90) or, when contraindicated, ACTH stimulation and/or CRH stimulation tests and a GH releasing hormonearginine test (nZ22). Clinical evaluation included quality of life questionnaires. Results: We studied 112 patients (75 males), with median age 48 years and mean body mass index (BMI) 26.7G4.8 kg/m 2 . Mean duration of hospitalization was 11 (3-105), and 33% of the patients had a severe trauma (Glasgow Coma Scale !9) after TBI. The mean duration of follow-up was 4 (1-12) years. Hypopituitarism was diagnosed in 5.4% (6/112) of patients: severe GH deficiency (nZ3), hypogonadism (nZ1), adrenal insufficiency (nZ2). Patients diagnosed with pituitary insufficiency had significantly higher BMI (PZ0.002). Conclusion: In this study, the prevalence of hypopituitarism during long-term follow-up after TBI was low. Prospective studies are urgently needed to find reliable predictive tools for the identification of patients with a significant pre-test likelihood for hypopituitarism after TBI.

show abstract

A Reappraisal of Diagnosing GH Deficiency in Adults: Role of Gender, Age, Waist Circumference, and Body Mass Index

Abstract: The results of the current study show that waist circumference and BMI are the strongest predictors of GH peak after GHRH+ARG followed by age. However, the old cutoff value of 9.0 microg/liter was in line with the new cutoffs in 95% of patients.

Cited by 60 publications

References 34 publications

The visceral adiposity index is associated with insulin sensitivity and IGF-I levels in adults with growth hormone deficiency

The visceral adiposity index is associated with insulin sensitivity and IGF-I levels in adults with growth hormone deficiency

Cross-sectional and longitudinal relation of IGF1 and IGF-binding protein 3 with lipid metabolism

Low prevalence of hypopituitarism after traumatic brain injury: a multicenter study

Contact Info

Product

Resources

About