Impact of discontinuation of growth hormone treatment on lipids and weight status in adolescents

Rothermel, Juliane; Lass, Nina; Bosse, Christina; Reinehr, Thomas

doi:10.1515/jpem-2017-0098

Cited by 7 publications

(7 citation statements)

References 26 publications

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“…GH induces lipolysis in adipocytes and plays an important role in the regulation of lipoprotein metabolism [ 1 ]; therefore, adult GHD may result in dyslipidemia and abdominal fat deposition. As observed in the present study, other studies have noted that patients with CO-GHD often experience unfavorable changes in their lipid profiles, with increased LDL cholesterol and triglyceride levels after discontinuing GH treatment when they reach their final height [ 28 - 30 ]. GH replacement therapy during the transition period has been associated with decreased levels of total and LDL cholesterol in some studies [ 10 , 15 , 27 ], but not all [ 8 , 26 , 31 ].…”

Section: Discussionsupporting

confidence: 73%

Metabolic Impacts of Discontinuation and Resumption of Recombinant Human Growth Hormone Treatment during the Transition Period in Patients with Childhood-Onset Growth Hormone Deficiency

et al. 2022

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Background: Discontinuing growth hormone (GH) treatment during the transition to adulthood has been associated with adverse health outcomes in patients with childhood-onset growth hormone deficiency (CO-GHD). This study investigated the metabolic changes associated with interrupting GH treatment in adolescents with CO-GHD during the transition period.Methods: This study included 187 patients with CO-GHD who were confirmed to have adult GHD and were treated at six academic centers in Korea. Data on clinical parameters, including anthropometric measurements, metabolic profiles, and bone mineral density (BMD) at the end of childhood GH treatment, were collected at the time of re-evaluation for GHD and 1 year after treatment resumption.Results: Most patients (n=182, 97.3%) had organic GHD. The median age at treatment discontinuation and re-evaluation was 15.6 and 18.7 years, respectively. The median duration of treatment interruption was 2.8 years. During treatment discontinuation, body mass index Z-scores and total cholesterol, low-density lipoprotein, and non-high-density lipoprotein (HDL) cholesterol levels increased, whereas fasting glucose levels decreased. One year after GH treatment resumption, fasting glucose levels, HDL cholesterol levels, and femoral neck BMD increased significantly. Longer GH interruption (>2 years, 60.4%) resulted in worse lipid profiles at re-evaluation. The duration of interruption was positively correlated with fasting glucose and non-HDL cholesterol levels after adjusting for covariates.Conclusion: GH treatment interruption during the transition period resulted in worse metabolic parameters, and a longer interruption period was correlated with poorer outcomes. GH treatment should be resumed early in patients with CO-GHD during the transition period.

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Section: Discussionsupporting

confidence: 73%

Metabolic Impacts of Discontinuation and Resumption of Recombinant Human Growth Hormone Treatment during the Transition Period in Patients with Childhood-Onset Growth Hormone Deficiency

et al. 2022

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“…Decrease in LDL-cholesterol and increase in HDL-cholesterol and triglycerides reported by Krebs and co-workers [126] were accompanied by positive changes, possibly associated with a reduction in cardiovascular risk, in potentially atherogenic parameters, including inflammatory markers and growth factor-related parameters, for example, lipoprotein-associated phospholipase A2 and high-sensitivity C-reactive protein [126]. Shortly after stopping GH in adolescents born SGA who had achieved adult height, triglycerides increased and HDL-cholesterol decreased significantly [128]; however, these findings were based on a small group of 21 patients born SGA. Several years after stopping GH, total cholesterol was similar to levels among untreated short adults born SGA [107].…”

Section: Lipid Profilementioning

confidence: 89%

What is the evidence for beneficial effects of growth hormone treatment beyond height in short children born small for gestational age? A review of published literature

Darendelıler

Kandemir

Harris

et al. 2019

Journal of Pediatric Endocrinology and Metabolism

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BackgroundAn increasing body of evidence supports the view that both an adverse intrauterine milieu and rapid postnatal weight gain in children born small for gestational age (SGA) contribute towards the risk for the development of chronic diseases in adult life.ContentThe aim of this review was to identify and summarize the published evidence on metabolic and cardiovascular risk, as well as risk of impaired cardiac function, intellectual capacity, quality of life, pubertal development and bone strength among children born SGA. The review will then address whether growth hormone (GH) therapy, commonly prescribed to reduce the height deficit in children born SGA who do not catch up in height, increases or decreases these risks over time.SummaryOverall, there are limited data in support of a modest beneficial effect of GH therapy on the adverse metabolic and cardiovascular risk observed in short children born SGA. Evidence to support a positive effect of GH on bone strength and psychosocial outcomes is less convincing.OutlookFurther evaluation into the clinical relevance of any potential long-term benefits of GH therapy on metabolic and cardiovascular endpoints is warranted.

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“…Increases in FM after GH cessation was accompanied by elevations in VAT in PWS adults. Since FM has been shown to increase after the cessation of GH therapy in a [29]. Higher VAT mass has been implicated in the reduced secretion of insulin-sensitizing adiponectin and increased secretion of inflammatory cytokines such as TNF-α and IL-6 [30].…”

Section: Discussionmentioning

confidence: 99%

Visceral adipose tissue increases shortly after the cessation of GH therapy in adults with Prader-Willi syndrome

et al. 2018

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GH therapy in pediatric patients with Prader-Willi syndrome (PWS) improves body composition, but discontinuation of GH after achieving adult height has been implicated in its deterioration. Although there is evidence for the deleterious effects of visceral adipose tissue (VAT) rather than subcutaneous adipose tissue (SAT) on the development of obesity-related complications, the effects of GH discontinuation on fat distribution in adults with PWS has not been fully investigated. Therefore, we utilized dual-energy X-ray absorptiometry (DEXA) and abdominal computed tomography (CT) to compare the fat distribution between before and 6 months or 12 months after the cessation of GH therapy in 7 adult PWS patients. GH therapy was initiated at a mean age of 4.1 ± 1.4 years and discontinued at a mean age of 18.9 ± 1.8 years. Serum IGF-1 levels were decreased by discontinuation of GH therapy. Fat mass was significantly increased 6 and 12 months after GH cessation, whereas muscle mass and bone mineral density were unchanged during both study periods. Abdominal CT analysis revealed that elevations in fat mass were due to increases in VAT rather than SAT. Circulating low-density lipoprotein (LDL) cholesterol levels were significantly elevated 6 months after GH cessation. In conclusion, discontinuation of GH therapy caused rapid increases in visceral adipose tissue and LDL cholesterol levels. These findings indicate that continuation of GH therapy may be a therapeutic option to maintain body composition; however, further studies regarding the long-term benefits and adverse effects of GH therapy in adults with PWS are required.

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Impact of discontinuation of growth hormone treatment on lipids and weight status in adolescents

Abstract: Discontinuation of GH treatment leads to a deterioration of lipids in TS, SGA and severe but not moderate GHD.

Cited by 7 publications

References 26 publications

Metabolic Impacts of Discontinuation and Resumption of Recombinant Human Growth Hormone Treatment during the Transition Period in Patients with Childhood-Onset Growth Hormone Deficiency

Metabolic Impacts of Discontinuation and Resumption of Recombinant Human Growth Hormone Treatment during the Transition Period in Patients with Childhood-Onset Growth Hormone Deficiency

What is the evidence for beneficial effects of growth hormone treatment beyond height in short children born small for gestational age? A review of published literature

Visceral adipose tissue increases shortly after the cessation of GH therapy in adults with Prader-Willi syndrome

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