Fifteen years of GH replacement improves body composition and cardiovascular risk factors

Abstract

ObjectiveFew studies have determined the effects of more than 5–10 years of GH replacement in adults on body composition and cardiovascular risk factors.Design/patientsIn this prospective, single-center, open-label study, the effects of 15 years of GH replacement on body composition and cardiovascular risk factors were determined in 156 hypopituitary adults (93 men) with adult-onset GH deficiency (GHD). Mean age was 50.5 (range 22–74) years at study start. Body composition was measured using dual-energy X-ray absorptiometry.ResultsThe mean initial GH dose of 0.55 (s.e.m. 0.03) mg/day was gradually lowered to 0.40 (0.01) mg/day after 15 years. The mean serum IGF1 SDS increased from −1.53 (0.10) at baseline to 0.74 (0.13) at study end (P<0.001 vs baseline). Lean soft tissue (LST) increased to 3% above the baseline level at study end (P<0.001). After a 9% decrease during the first year of treatment (P<0.001 vs baseline), body fat (BF) started to increase and had returned to the baseline level after 15 years. Serum levels of total cholesterol and LDL-cholesterol decreased and serum HDL-cholesterol level increased. Fasting plasma glucose increased from 4.4 (0.1) at baseline to 4.8 (0.1) mmol/l at study end (P<0.001). However, blood HbA1c decreased from 5.0 (0.1) to 4.6 (0.1) % (P<0.001).ConclusionsFifteen-year GH replacement in GHD adults induced a transient decrease in BF and sustained improvements of LST and serum lipid profile. Fasting plasma glucose increased whereas blood HbA1c was reduced.

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

“…GHD patients usually have decreased HDL and increased LDL cholesterol, as we found in our study, and the beneficial effects of GHT have been well documented, although a limitation of most studies is the lack of data concerning lipid-lowering treatment or the chronic use of these [35]. Our data, showing an improvement in total and HDL cholesterol in patients not receiving specific treatment, are in agreement with a series of studies which have confirmed that long-term GHT leads to a significant improvement in lipid profile [41], although other studies did not report any significant effect [42,43]. In addition, the neutral effect of GHD and GHT on triglycerides observed in our study is in agreement with the meta analysis performed by Maison et al [30].…”

DIAGNOSIS OF ENDOCRINE DISEASE: Endocrine late-effects of childhood cancer and its treatments

“…There are no specific guidelines regarding the observation time needed in children treated for non-malignant CNS tumors such as craniopharyngioma (56). Over the past two decades, the use of hGH has been extended to GH-deficient adults, given the possible benefits on lipids, bone mass, body composition and quality of life (61,62). However, there are no studies demonstrating a lasting benefit of treating GHD specifically in adult CCS (12).…”

Growth hormone replacement in adults – current standards and new perspectives

“…The majority of studies have displayed results for GH treatment for 2e3 years, and only a few studies dealt with the results for longer-term follow-up. In a study reporting on results of GH replacement for 15 years it was shown that the improvement in LBM was sustained while the FM returned to the levels the patients had at start of GH treatment [34]. Muscle mass, muscle strength and physical capacity increase [35] and the heart function improve [36].…”