Impairment of lung volumes and respiratory muscle strength in adult patients with growth hormone deficiency

Merola, B; Sofia, Matteo; Longobardi, Salvatore; Fazio, Serafino; Micco, Assunta; Esposito, Vincenzo; Colao, Annamaria; Biondi, Bernadette; Lombardi, Gaetano

doi:10.1530/eje.0.1330680

Cited by 18 publications

(13 citation statements)

References 17 publications

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“…However, this is not the case in our patient as the plasma levels of thyroid hormones were within normal ranges with hormone substitution when he was diagnosed as respiratory failure. On the other hand, it is also reported that adult patients with GH deficiency showed moderate impairment of ventilatory function6 and that GH replacement therapy reversed that function 7. While it has been postulated that respiratory dysfunction in patients with GH deficiency might be due to weakened respiratory muscle strength and a reduction of lung volumes,7 there are no reports, to our knowledge, showing that GH deficiency resulted in severe respiratory failure as in our case.…”

Section: Discussionsupporting

confidence: 51%

Respiratory failure was improved by growth hormone substitution in a patient with hypopituitarism

Sato¹,

Yokoyama

Ryuge

et al. 2010

Case Reports

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A 33-year-old man was referred to the Department of Respiratory Medicine in our hospital due to severe hypercapnic respiratory failure in March 2008. His respiratory function test showed severe restrictive pulmonary dysfunction, and respiratory muscle strength assessed by measuring maximal static expiratory and inspiratory mouth pressures was severely impaired. After non-invasive positive pressure ventilation was started, he was referred to the Endocrinology Department as he was diagnosed as hypopituitarism in his childhood. Pituitary MRI demonstrated pituitary stalk agenesis, and hormonal examination showed that he had severe growth hormone (GH) deficiency. GH replacement therapy was started in August 2008 and his arterial blood gas values and respiratory muscle strength were improved in 6 months. The current case demonstrated that GH deficiency could be a cause of severe respiratory failure.

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Section: Discussionsupporting

confidence: 51%

Respiratory failure was improved by growth hormone substitution in a patient with hypopituitarism

Sato¹,

Yokoyama

Ryuge

et al. 2010

Case Reports

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“…For instance, large lungs (Bartlett, 1971), upper airflow obstruction (Trotman-Dickenson et al, 1991), and narrowing of the small airways (Harrison et al, 1978) accompany GH excess, whereas a decrease in muscle strength and a reduction in the maximum inspiratory and expiratory pressure (Merola et al, 1995(Merola et al, , 1996 are associated with GH deficiency. The possibility that the lung is a target site for GH action is also indicated by the GH-induced production of superoxide by alveolar macrophages (Edwards et al, 1992), the GH-induced increase in circulating lung neutrophil activation during sepsis, and the accompanying increase in microvascular injury (Liu et al, 2002a).…”

Section: Introductionmentioning

confidence: 99%

Growth hormone expression in the perinatal and postnatal rat lung

Beyea

Olson

Harvey

2005

Developmental Dynamics

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It is now established that the lung is a target site for pituitary growth hormone (GH) action, because pathophysiological states of pituitary GH excess and deficiency are associated with impaired pulmonary function. The onset of lung development and differentiation is, however, before the ontogenic differentiation of pituitary somatotrophs. GH may be involved, nevertheless, in lung development, because it is present in extrapituitary tissues of preimplantation mouse embryos and in the lung buds of embryonic chickens. The possibility that GH may be expressed in the rat lung during fetal and neonatal development, therefore, has been assessed. GH mRNA was detected in the lung, and its 693-bp sequence was identical to that in the pituitary gland. By in situ hybridization, this transcript was found to be abundantly expressed in the lungs of embryonic day (ED) 17 rats in mesenchymal, mucosal epithelial, and smooth muscle cells. This transcript was expressed in neonates until at least day 14 postnatally and was localized to type I and II epithelial cells and to pulmonary tissue macrophages and alveolar macrophages. GH immunoreactivity paralleled GH mRNA cellular localization throughout the time course studied. This immunoreactivity was specific and was lost after antibody preabsorption. The perinatal and postnatal lung is, therefore, an extrapituitary site of GH gene expression during development. Given that the GH receptor is present in the lung from early development, lung GH may have autocrine and/or paracrine roles in lung growth or differentiation or in pulmonary function.

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“…The present patient also developed hypoxia and hypercapnia due to the markedly decreased VC. Adult patients with CPHD have been reported to show impairment of ventilatory function, and GH-replacement therapy can help restore it [4,11,12]. It has also been reported that GH-replacement therapy for GHD in adults results in increased maximal oxygen uptake, presumably due to increased respiratory muscle strength [13] and increased mean frequency of the surface electromyogram of the muscle fiber area in quadriceps [14].…”

Section: Discussionmentioning

confidence: 99%

“…Various hormone disturbances are therefore associated with impairment of respiratory muscle function [3]. For example, adult patients affected by childhood-onset GHD reportedly develop impaired ventilatory function due to reduced lung volumes and respiratory pressures, probably due to reductions in respiratory muscle strength [4]. In addition, GH is known to play a role in stimulating the glomerular filtration rate (GFR) [5,6], and GFR is decreased in patients with GHD [7].…”

Section: Introductionmentioning

confidence: 99%

Growth hormone deficiency with late-onset hypothalamic hypoadrenocorticism associated with respiratory and renal dysfunction: a case report

et al. 2020

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Background: The prevalence of childhood-onset growth hormone (GH) deficiency (GHD) is estimated to be approximately 1 in 5000 or more, with the cause unknown in most cases (idiopathic isolated GHD). However, additional disorders of secretion of other pituitary hormones reportedly develop over time, with a frequency of 2-94% (median, 16%). Furthermore, median times to development of other anterior pituitary hormone deficiencies have been reported to be 6.4-9.4 years. On the other hand, adult patients affected by childhood-onset GHD reportedly develop impaired ventilation function due to reduced lung volumes and respiratory pressures, probably due to reductions in respiratory muscle strength. In addition, GH is known to play a role in stimulating the glomerular filtration rate (GFR), and the estimated GFR (eGFR) is decreased in patients with GHD. Case presentation: This case involved a 65-year-old woman. Her short stature had been identified at around 3 years of age, but no effective treatments had been provided. The patient was mostly amenorrheic, and hair loss became apparent in her late 30s. She developed hyperuricemia, dyslipidemia, and hypertension at 45 years of age. In addition, the patient was diagnosed with hypothyroidism at 50 years of age. At 58 years of age, endocrinological examination showed impaired secretion of thyroid-stimulating hormone, luteinizing hormone/follicle-stimulating hormone, and growth hormone, and magnetic resonance imaging showed an empty sella turcica. However, secretion ability of adrenocorticotropic hormone was retained. At 63 years of age, respiratory function tests confirmed a markedly restricted ventilation disorder (vital capacity, 0.54 L; percentage predicted vital capacity, 26.9%). Renal function had also decreased (eGFR, 25.0 mL/min/1.73 m 2 ). Furthermore, she was diagnosed with hypothalamic secondary hypoadrenocorticism. The patient developed CO 2 narcosis at 65 years of age, and noninvasive positive pressure ventilation was started.(Continued on next page)

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Impairment of lung volumes and respiratory muscle strength in adult patients with growth hormone deficiency

Cited by 18 publications

References 17 publications

Respiratory failure was improved by growth hormone substitution in a patient with hypopituitarism

Respiratory failure was improved by growth hormone substitution in a patient with hypopituitarism

Growth hormone expression in the perinatal and postnatal rat lung

Growth hormone deficiency with late-onset hypothalamic hypoadrenocorticism associated with respiratory and renal dysfunction: a case report

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