Growth Hormone Deficiency in Adulthood and the Effects of Growth Hormone Replacement: A Review

Carroll, Paul; Christ, Emanuel; Bengtsson, Bengt; Carlsson, Lena; Christiansen, Jens Sandahl; Clemmons, David R.; Hintz, Raymond L.; Ho, Ken K. Y.; Laron, Zvi; Sizonenko, P; Sönksen, P. H.; Tanaka, Toshiaki; Thorne, Michael

doi:10.1210/jcem.83.2.4594

Cited by 710 publications

(509 citation statements)

References 163 publications

(209 reference statements)

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“…Two plausible hypotheses can be considered. Firstly, reduced GH secretion might allow for accumulation of abdominal fat, as suggested by observations in adults with GH deficiency due to hypothalamic-pituitary disease 30 and by the reduction of abdominal fat observed after GH treatment in abdominally obese men. 31 Alternatively, the raised plasma insulin levels associated with visceral fat excess 32 might provide a negative feedback on GH secretion.…”

Section: Discussionmentioning

confidence: 99%

Daylong pituitary hormones in morbid obesity: effects of bariatric surgery

et al. 2008

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Moderate obesity is known to be associated with multiple endocrine abnormalities. Less information is available on the hormonal status of patients with morbid obesity and on the effects of major weight loss. We studied 16 severely obese (BMI 40.6-69.9 kg/m 2 ) nondiabetic patients and 7 nonobese (BMI range 24.6-27.7 kg/m 2 ), sex-and age-matched healthy volunteers. During 24 h in a metabolic ward, four meals were administered and hourly blood samples were drawn from a central venous catheter for the measurement of glucose, insulin, leptin, thyrotropic hormone (TSH), growth hormone (GH) and prolactin. Insulin sensitivity was measured by a euglycaemic hyperinsulinaemic clamp. Studies were repeated 6 months after biliopancreatic diversion, a mainly malabsorptive surgical approach, which caused an average weight loss of 35±4 kg (or 26 ± 2% of initial weight). Compared with controls, patients were hyperinsulinaemic (290 ± 31 vs 88 ± 4 pmol l À1 , P ¼ 0.0002), insulin resistant (23.5±2.8 vs 52.9±4.9 mmol min À1 kg FFM À1 , P ¼ 0.0006) and hyperleptinaemic (52.5±5.8 vs 10.9±3 ng ml À1 , P ¼ 0.0002). Plasma TSH levels were increased throughout the day-night cycle (averaging 2.02 ± 0.18 vs 1.09 ± 0.19 mU ml À1 of controls, P ¼ 0.01), whereas serum GH levels were suppressed (0.46±0.10 vs 3.01±1.15, P ¼ 0.002). Following surgery, the hyperinsulinaemia and insulin resistance were fully normalized; in concomitance with a major drop in leptin levels (to 14.4±2.7 ng ml À1 , P ¼ 0.02), TSH decreased and GH increased to near-normal levels. In the whole dataset, mean 24-h leptin levels were directly related to mean 24-h TSH levels after controlling for confounders this relationship was lost only after adjusting for fat mass. We conclude that in morbid obesity leptin is a determinant of changes in pituitary function.

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Section: Discussionmentioning

confidence: 99%

Daylong pituitary hormones in morbid obesity: effects of bariatric surgery

et al. 2008

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“…Epidemiological studies suggest that patients with adult GHD are at increased risk of cardiovascular and cerebrovascular mortality. On the other hand, GH therapy in adult GHD has been shown to normalize body composition, increase bone density and cardiac function, improve physical and health-related quality of life, and have beneficial effects on lipid metabolism [4]. Although the clinical findings, complications, and prognosis of adult GHD in Japan have been surveyed using a questionnaire [5,6], the clinical characteristics of adult patients with GHD at a single institute have not been reported.…”

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Metabolic Disorders in Adult Growth Hormone Deficiency: A Study of 110 Patients at a Single Institute in Japan

et al. 2006

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Abstract. The purpose of this study carried out at a single institute in Japan was to investigate the clinical characteristics and complications of patients with adult growth hormone deficiency (GHD). Clinical and biochemical data of 110 patients (50 males, 60 females; mean age 42 ± 17 yr) with adult GHD who attended Tokyo Women's Medical University between 1990 and 1999 were analyzed retrospectively from medical records. This retrospective analysis demonstrated that 109 patients had multiple pituitary hormone deficiencies, with 98 patients having a deficiency of more than three hormones. Sixty-one patients had childhood onset GHD (COGHD) while the remaining 49 patients had adulthood onset GHD (AOGHD). Body mass index (BMI) ranged from 16.9 to 35.9 with a mean of 23.9 ± 4.1 (kg/m 2 ), with BMI being ≥25 kg/ m 2 in 38 patients (31% of COGHD and 38% of AOGHD). Forty-one percent of the patients had hypercholesterolemia, 41% had hypertriglyceridemia, 47% had decreased levels of HDL cholesterol and 48% had increased levels of LDL cholesterol. Intima-media thickness (IMT) of the carotid arteries was investigated in 33 patients, with abnormal findings including increased IMT or plaque being observed in 4 of 18 COGHD patients and 4 of 15 AOGHD patients. Diabetes mellitus and impaired glucose tolerance was found in 4 COGHD patients and 16 AOGHD patients. Insulin resistance was assessed in 36 patients by the homeostasis model insulin resistance index (HOMA-R) and ranged from 0.65 to 10.58 with a mean of 2.80 ± 0.37. This mean value of HOMA-R was significantly greater than that measured in normal subjects (1.58 ± 0.05: P<0.05). These data suggest that abnormal lipid and glucose metabolism, and atherosclerotic changes occur frequently in adult patients with GHD. Insulin resistance may play a role in glucose and lipid metabolism disorders associated with GHD.

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“…A probabilidade de DGH (critério de pico de GH utilizado variando de <2,3 a <5,0µg/L) em pacientes com hipopituitarismo acometendo os eixos gonadotrófico, tirotrófico e adrenocorticotrófico, com ou sem diabetes insipidus, é extremamente elevada, situando-se entre 91% e 100% (24)(25)(26)(27). Nesses casos, o diagnósti-co pode ser estabelecido pelo achado de níveis séricos baixos de IGF-1, sem recorrer a testes de secreção do GH (28). Por outro lado, na ausência de outras defi- (29).…”

Section: Quadro Clínico E Diagnósticounclassified

Terapia de reposição hormonal no hipopituitarismo

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et al. 2003

Arq Bras Endocrinol Metab

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Arq Bras Endocrinol Metab vol 47 nº 4 Agosto 2003 492 RESUMOEsse artigo traz uma revisão do hipopituitarismo com ênfase na terapia de reposição hormonal. O conhecimento das bases fisiológicas da terapia de reposição hormonal, assim como dos aspectos práticos do tratamento, constitui o suporte racional para tratar esses pacientes. Essa revisão foi organizada por deficiência hormonal e cada um desses tópi-cos inclui epidemiologia, etiologia, apresentação clínica, diagnóstico, preparações hormonais disponíveis para o tratamento de cada deficiência, dosagens, vias de administração, efeitos colaterais e monitorização clínico-laboratorial durante os diferentes períodos da vida para cada reposição hormonal: hormônio de crescimento na criança e no adulto, hormônios tiroideanos no hipotiroidismo central, glicocorticóides no hipoadrenalismo central, análogos de vasopressina no diabetes insípidus central, esteróides sexuais no homem e na mulher, da puberdade à senescência e gonadotrofinas no tratamento da infertilidade. As informações aqui contidas resultam de uma revisão crítica da literatura aliada à nossa experiência de mais de duas décadas no diagnóstico e tratamento do paciente hipopituitário na Unidade de Neuroendocrinologia da Universidade ABSTRACT Hormone Replacement Therapy in HypopituitarismThis article brings an updated review of hypopituitarism with emphasis in hormone replacement therapy. The physiological basis of hormone replacement therapy and practical aspects of treating hypopituitary patients were both taken into account to provide a rational strategy for treatment. The review is organized by individual pituitary hormone deficiency and covers epidemiology, etiology, clinical presentation, and diagnosis of hypopituitarism, as well as the most relevant hormone preparations currently available for treating each hormone deficiency. Practical guidelines to hormone dosing, routes of administration, side effects and clinical and laboratory monitoring during the entire lifespan are given for each individual hormone replacement therapy: growth hormone in GH-deficient children and adults, thyroid hormone in central hypothyroidism, glucocorticoid in central hypoadrenalism, vasopressin analogs in diabetes insipidus, sex hormones in man and women from puberty to senescence, and gonadotropins for treating infertility. In addition to the literature review, we took into account our own experience of more than two decades in investigating, diagnosing, and treating hypopituitary patients at the Universi-

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Growth Hormone Deficiency in Adulthood and the Effects of Growth Hormone Replacement: A Review

Cited by 710 publications

References 163 publications

Daylong pituitary hormones in morbid obesity: effects of bariatric surgery

Daylong pituitary hormones in morbid obesity: effects of bariatric surgery

Metabolic Disorders in Adult Growth Hormone Deficiency: A Study of 110 Patients at a Single Institute in Japan

Terapia de reposição hormonal no hipopituitarismo

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