Growth Hormone Secretion and Leptin in Morbid Obesity before and after Biliopancreatic Diversion: Relationships with Insulin and Body Composition

Marinis, Laura De; Bianchi, Antonio; Mancini, Antonio; Gentilella, R.; Perrelli, Michele; Giampietro, Antonella; Porcelli, Teresa; Tilaro, L.; Fusco, Alessandra; Valle, Domenico; Tacchino, Roberto M.

doi:10.1210/jc.2002-021308

Cited by 82 publications

(63 citation statements)

References 63 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In the diagnostic approach for GH deficiency obesity presents a great limitation since it is characterized by a low response to all provocative stimuli for GH secretion (26)(27)(28)(29)(30)(31)(32)(33). In obesity reduction in the half-life of GH (43) as well as a significant decrease in the production and secretion of the hormone have been reported (44).…”

Section: Discussionmentioning

confidence: 99%

The cut-off limits of the GH response to GH-releasing hormone-arginine test related to body mass index

et al. 2005

View full text Add to dashboard Cite

Objective: The diagnosis of growth hormone (GH) deficiency (GHD) in adults is based on a reduced peak GH response to provocative tests, such as the insulin tolerance test (ITT) and the GH-releasing hormone-arginine (GHRH-ARG) test. However, the cut-off limits of peak GH response in lean subjects are not reliable in obese patients; this is noteworthy since adult GHD is often associated with obesity. Aim of this study was to evaluate the diagnostic cut-off limits of peak GH response to the GHRH-ARG test in overweight and obese as well as in lean population. Design and methods: The GH responses to the GHRH-ARG test were studied in 322 patients with organic hypothalamic-pituitary disease and in 318 control subjects. Patients were subdivided into two groups on the basis of the number of pituitary hormone deficits, except for GH deficiency: (a) patients with total pituitary hormone deficit (TPHD) and (b) patients without or with no more than two pituitary hormone deficits (PHD). Both patients and control subjects were divided into three subgroups according to body mass index (BMI): lean (BMI , 25 kg/m 2 ), overweight (BMI $ 25 and , 30 kg/m 2 ) and obese (BMI $30 kg/m 2 ). TPHD patients were assumed to be GH deficient, whereas PHD patients may include subjects with either normal or impaired GH secretion. The statistical analysis was carried out by the Receiver-Operating Characteristic curve analysis (Medcalc 7.2). The diagnostic cut-off points were calculated for lean, overweight and obese subjects to provide optimal separation of GH-deficient patients and control subjects according to two criteria: (1) a balance between high sensitivity and high specificity; (2) to provide the highest pair of sensitivity/specificity values for GH deficiency. Results: In the lean population the best pair of values, with highest sensitivity as 98.7% and highest specificity as 83.7%, was found using a peak GH cut-off point of 11.5 mg/l. In the overweight population the best pair of values, 96.7 and 75.5%, respectively, was found using a peak GH cut-off point of 8.0 mg/l. In the obese population the best pair of values, 93.5 and 78.3%, respectively, was found using a peak GH cut-off point of 4.2 mg/l. Applying the above mentioned cut-off points, among PHD patients we found that 80 subjects (72%) were GHD whereas 31 (28%) had normal GH secretion. Conclusions: In conclusion the GHRH-ARG test is a reliable tool for the diagnosis of adult GH deficiency in lean, overweight and obese patients, provided that specific BMI-related cut-off limits are assumed.European Journal of Endocrinology 153 257-264

show abstract

Section: Discussionmentioning

confidence: 99%

The cut-off limits of the GH response to GH-releasing hormone-arginine test related to body mass index

et al. 2005

View full text Add to dashboard Cite

show abstract

“…In parallel, GH and IGF-I secretion increased in both men and women and resulted in a partial restoration of the GH/IGF-I axis. Metabolic markers such as lipids and glucose/insulin levels have been extensively studied, while there are only two reports (24,25) examining the GH/IGF-I axis after massive weight loss (in nine and 15 subjects before and after massive weight loss respectively). The present findings based on 63 subjects seem to be in line with other studies regarding GH secretion in obese, fasting and anorectic states (26,27).…”

Section: Discussionmentioning

confidence: 99%

Effects of gastric bypass on the GH/IGF-I axis in severe obesity – and a comparison with GH deficiency

Engström¹,

Burman²,

Holdstock³

et al. 2006

eur j endocrinol

View full text Add to dashboard Cite

Objective: Overfeeding suppresses GH secretion and makes evaluation of a suspected GH deficiency (GHD) difficult. In normal weight subjects, gender is known to influence GH concentrations, which is most apparent in the ambulatory, morning-fasted state. In this study, we examined the GH/IGF-I axis in obese men and women and the effect of surgically induced weight loss. Design: Sixty-three subjects (body mass index (BMI) 45^6 kg/m 2 ; 54 women, 9 men) were studied prior to, and 6 and 12 months following Roux-en-Y gastric bypass (RYGBP) surgery. Fifty-four patients with classic GHD (BMI 27^6 kg/m 2 ; 35 men, 19 women) were included for comparison. Methods: Hormones were analysed in fasting morning serum samples. Results: RYGBP resulted in a decreased BMI to 35^kg/m 2 at 6 months and 32^6 kg/m 2 at 12 months. GH and IGF-I increased at 6 months in the women and at 12 months in both sexes by $ 300 and 11% respectively. Prior to RYGBP, GH concentrations were low in the obese men and similar to those of GHD men (mean 0.09 mU/l). Obese women had tenfold higher values than obese men and sevenfold higher than GHD women. IGF-I levels were in the low reference range in the obese and below 22 S.D. for age in 13%. Conclusions: Surgically induced weight loss partially restores GH secretion. Despite a marked suppression of GH values, a gender influence is maintained in severe obesity. In obese women, single morning GH and IGF-I values seem sufficient to exclude a suspicion of classic GHD.European Journal of Endocrinology 154 53-59

show abstract

“…The lack of stimulation of GH release in obese subjects by diet may promote retention of fat mass. However, studies have demonstrated that apparently all the defects in the GH IGF-I axis in obesity are reversible with diet-induced and surgical induced large weight loss (20,56,70). The recovery of the GH IGF-I axis after weight loss suggest an acquired defect, rather than a pre-existing disorder.…”

Section: Effect Of Caloric Restriction and Weight Loss On The Gh-igf-mentioning

confidence: 99%

Obesity, growth hormone and weight loss

Rasmussen

2010

Molecular and Cellular Endocrinology

105

View full text Add to dashboard Cite

Growth hormone (GH) is the most important hormonal regulator of postnatal longitudinal growth in man. In adults GH is no longer needed for longitudinal growth. Adults with growth hormone deficiency (GHD) are characterised by perturbations in body composition, lipid metabolism, cardiovascular risk profile and bone mineral density. It is well established that adult GHD usually is accompanied by an increase in fat accumulation and GH replacement in adult patients with GHD results in reduction of fat mass and abdominal fat mass in particular. It is also recognized that obesity and abdominal obesity in particular results in a secondary reduction in GH secretion and subnormal insulin-like growth factor-I (IGF-I) levels. The recovery of the GH IGF-I axis after weight loss suggest an acquired defect, however, the pathophysiologic role of GH in obesity is yet to be fully understood. In clinical studies examining the efficacy of GH in obese subjects very little or no effect are observed with respect to weight loss, whereas GH seems to reduce total and abdominal fat mass in obese subjects. The observed reductions in abdominal fat mass are modest and similar to what can be achieved by diet or exercise interventions.

show abstract

Growth Hormone Secretion and Leptin in Morbid Obesity before and after Biliopancreatic Diversion: Relationships with Insulin and Body Composition

Cited by 82 publications

References 63 publications

The cut-off limits of the GH response to GH-releasing hormone-arginine test related to body mass index

The cut-off limits of the GH response to GH-releasing hormone-arginine test related to body mass index

Effects of gastric bypass on the GH/IGF-I axis in severe obesity – and a comparison with GH deficiency

Obesity, growth hormone and weight loss

Contact Info

Product

Resources

About