Growth hormone status predicts left ventricular mass in patients after cure of acromegaly

Abstract

Context Growth hormone excess and growth hormone deficiency (GHD) are both associated with increased cardiovascular morbidity. A specific acromegaly-related cardiomyopathy has been described, characterized in part by increased left ventricular mass (LVM). Growth hormone deficiency is associated with reduced LVM. Following cure of acromegaly with surgery or radiation therapy, GHD may develop; however, its effects on cardiac morphology and function in this population are not established. Objective We hypothesized that the development of GHD in patients with prior acromegaly would be associated with cardiacmorphologic and functional changes that differ from those in patients who are GH sufficient following cure of acromegaly. Design A cross-sectional study was conducted in a Clinical Research Center. Study participants consisted of three groups of subjects (n=34): I. Cured acromegaly with GHD (n=15), II. Cured acromegaly with GH sufficiency (n=8), and III. Active acromegaly (n=11). Main outcome measures included cardiac morphology and function, using echocardiography parameters. Results Mean age and BMI, 44.6±2.3 years (SEM) and 30.7±1.3 kg/m2, respectively, were not different among the three groups. Mean peak GH values were: I. 2.8±0.4 ng/ml; II. 30.1±9.1 ng/ml (p=0.0002.) In group I, left ventricular mass, indexed to body surface area (LVMi), was within the normal range in all patients; moreover, left ventricular (LV) geometry was normal. At least 50% of patients in groups II and III had elevated LVMi, and in 50% of patients, LV geometry was abnormal, indicating pathologic hypertrophy. Ejection fraction was similar between all three groups. There were no significant differences in diastolic function. Conclusions Patients who develop GHD following cure of acromegaly do not demonstrate elevated LV mass, in contrast to patients with a history of acromegaly but normal GH levels or to patients with active acromegaly. This suggests that GH status after treatment of acromegaly correlates with LV mass, and that, in GH sufficient patients, reversal of remodeling may be slower than previously thought. These data suggest that it will be important to determine whether GH replacement alters left ventricular morphology over time.

Effects of growth hormone deficiency on body composition and biomarkers of cardiovascular risk after definitive therapy for acromegaly

“…The trial is registered at ClinicalTrials.gov, number NCT00182091. Clinical characteristics, body composition and cardiovascular risk results on a subset of the GHD group have been previously published as baseline results of a longitudinal study, clinical characteristics of a subset of the GHD and GHS groups have been previously published, and echocardiographic measurements on a subset of the three groups have also been previously published; but no body composition or cardiovascular risk marker data have been previously published for the GHS or AA groups.…”

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

“…Also, the acromegaly-related cardiac abnormalities could worsen after the development of GHD [101]. However, clinical studies do not fully confirm these theoretical hypotheses, as they found a BMI slightly increased [102][103][104] or, even, similar [105][106][107][108] in acroGHD compared to GHD and acromegalic populations. At the same time, while one work reported that acroGHD patients were more hypertensive, dyslipidemic, and diabetic than GHD subjects [109], other Authors pointed out a comparable prevalence of glucose abnormalities and dyslipidemia, as well as a similar amount of body fat and lean mass between acroGHD and refcerebrovascular [5, [82][83][84][85][86][87].…”

Effect of growth hormone treatment on diastolic function in patients who have developed growth hormone deficiency after definitive treatment of acromegaly

“…We have previously shown that individuals with a history of acromegaly who develop GHD have normal, not reduced, left ventricular mass corrected for body surface area (LVM/BSA) whereas more than 50% of individuals with a history of acromegaly and GH sufficiency have elevated LVM/BSA [37]. Therefore whether treatment with GH is safe in patients with acroGHD in regard to cardiovascular risk remains largely unknown.…”