Effects of human recombinant growth hormone on exercise capacity, cardiac structure, and cardiac function in patients with adult-onset growth hormone deficiency

Abstract

ObjectiveEpidemiological studies suggest that adult-onset growth hormone deficiency (AGHD) might increase the risk of death from cardiovascular causes.MethodsThis was a 6-month double-blind, placebo-controlled, randomised, cross-over trial followed by a 6-month open-label phase. Seventeen patients with AGHD received either recombinant human growth hormone (rGH) (0.4 mg injection daily) or placebo for 12 weeks, underwent washout for 2 weeks, and were then crossed over to the alternative treatment for a further 12 weeks. Cardiac magnetic resonance imaging, echocardiography, and cardiopulmonary exercise testing were performed at baseline, 12 weeks, 26 weeks, and the end of the open phase (12 months). The results were compared with those of 16 age- and sex-matched control subjects.ResultsAt baseline, patients with AGHD had a significantly higher systolic blood pressure, ejection fraction, and left ventricular mass than the control group, even when corrected for body surface area. Treatment with rGH normalised the insulin-like growth factor 1 concentration without an effect on exercise capacity, cardiac structure, or cardiac function.ConclusionAdministration of rGH therapy for 6 to 9 months failed to normalise the functional and structural cardiac differences observed in patients with AGHD when compared with a control group.

Effects of adult growth hormone deficiency and replacement therapy on the cardiometabolic risk profile

“…Significant changes of the right ventricular parameters were not found either [ 49 ]. Gonzalez et al employed echocardiography, CMRI and cardiopulmonary exercise testing and experienced higher systolic blood pressure (SBP), ejection fraction (EF) and LV mass in AGHD patients with no changes in exercise capacity, systolic function and cardiac structure after 9 months of GHRT [ 50 ]. More recently, De Cobelli et al have demonstrated reduced LV mass with normal resting systolic function as well as subclinical diastolic dysfunction in untreated GHD patients.…”

MRI Assessment of Cardiac Function and Morphology in Adult Patients With Growth Hormone Deficiency: A Systematic Review and Meta-Analysis

“…An accurate title or abstract revision was sufficient to exclude 139 articles as not pertinent or not fulfilling our prespecified inclusion or exclusion criteria. The remaining 8 studies were assessed in full-text for eligibility (42)(43)(44)(45)(49)(50)(51)(52), and 4 of them were excluded due to patient overlap (49-52); thus, 4 studies finally met all criteria for being included in the final analysis (42-45) (Figure 1).…”

“…Given these premises, cardiac MRI might provide finer information about cardiac alterations in patients with adult GHD, as well as their possible changes after the initiation of rhGH replacement therapy; in particular, it might answer to the question about if and how RV is involved. Some studies have been published in this regard (42)(43)(44)(45), with interesting results. However, the strength of their conclusions is hampered by their limited sample size, and a quantitative synthesis of their results is still lacking.…”

Evaluations of exercise intolerance with cardiopulmonary exercise tests in an 18-year-old adolescent with pituitary stalk interruption syndrome: a case report

“…On the other hand, a double-blind, placebo-controlled randomized, cross-over trial enrolled 17 patients with acquired hormone deficiency to receive recombinant human growth hormone or placebo, but the exercise capacity remained unchanged. [ 25 ] Another similar study suggested that 3 months of GH replacement improved muscle oxidative capacity by comparing succinate dehydrogenase density in quadriceps muscle biopsies, which should reflect an improvement in exercise capacity. [ 26 ] However, no significant effects in peak VO 2 , VE/VCO 2 slope, anaerobic threshold RER, exercise time were noticeable, while the authors considered it could be contributed by short period of therapy, low dose of GH or an obese population.…”