GH replacement therapy in elderly GH-deficient patients: a systematic review

Abstract

Context: Recombinant human GH (rhGH) is prescribed for the treatment of adults with GH deficiency (GHD). However, conflicting data are available on the efficacy of rhGH treatment in elderly GHD patients. Objective: To assess the efficacy of rhGH treatment in elderly GHD subjects. Methods: We searched the available literature in PubMed, Cochrane Library, Web of Science and EMBASE. Study selection: Studies on GHD patients, aged O60 years, treated with rhGH were eligible for inclusion. Data extraction was performed by two reviewers independently. Results: We found 11 eligible studies with a total of 534 patients. Only two studies had prospective, randomized, placebo-controlled study designs of rhGH treatment with a duration of 6 (nZ15) and 12 months (nZ62), respectively. Treatment with rhGH decreased total and low density lipoprotein (LDL) cholesterol levels by 4-8 and 11-16%, respectively, but did not alter high density lipoprotein or triglyceride levels. RhGH did not affect body mass index, but decreased waist circumference (by w3 cm) and waist/hip ratio. RhGh did not consistently affect blood pressure or bone mineral density. RhGH increased lean body mass by 2-5% and decreased total fat mass by 7-10% in four studies, but did not affect body composition in two other studies. RhGH consistently improved quality of life (QoL) parameters reflected in AGHDA-scores. There were no explicit data on elderly GHD patients aged O80 years. Conclusion: RhGH replacement in elderly subjects with GHD decreases LDL cholesterol levels and improves QoL, but the effects on other parameters are not unequivocal. There were no data on the efficacy and safety of rhGH treatment in octogenarians with GHD.

Growth hormone co-treatment in IVF/ICSI cycles in poor responders

“…In our study, probability of pregnancy significantly increased in the GH þ group. Potential side-effects observed with GH treatment include increased fluid retention, resulting in edema, headaches and/or joint pain, neoplasms, cerebrovascular events, and altered glucose metabolism [17]. However, GH co-treatment in IVF/ICSI cycles is not associated with any adverse events except for slight edema.…”

Effects of discontinuation of growth hormone replacement in adult GH-deficient patients: a cohort study and a systematic review of the literature

“…Next, we also conducted a sub-analysis in elderly subjects (age >60 years, n = 34). The age of 60 years was chosen as cutoff because the effects of GH replacement therapy in GHD patients aged >60 years are not well established (16).…”

“…As GH secretion and IGF-1 levels decrease in healthy adults with advancing age and low IGF-1 levels are even associated with increased longevity and decreased morbidity both in animal models and in humans, it is questionable whether the beneficial effects of rhGh replacement will be sustained in elderly patients (14,15). Studies reporting on the efficacy of rhGh replacement in elderly (>60 years) GHD patients are limited and show inconclusive results, and data on rhGh discontinuation in adult GHD are scarce (16).…”

Impact of adult growth hormone deficiency on metabolic profile and cardiovascular risk [Review]

“…In this specific cohort of patients, GH replacement therapy positively and unequivocally affects total and LDL cholesterol levels, whereas it does not improve plasma triglyceride levels [98]. Controversy exists on the effects of the therapy on other cardiovascular risk factors, including insulin, HDL cholesterol, blood pressure and body composition [98].…”

“…Controversy exists on the effects of the therapy on other cardiovascular risk factors, including insulin, HDL cholesterol, blood pressure and body composition [98]. Only one study evaluated the effects of replacement therapy on cardiac noninvasive structural and functional parameters in elderly GH deficient patients and reported non significant changes after 12 months [99].…”