Long-term growth hormone (GH) replacement of adult GH deficiency (GHD) benefits the heart

Abstract

Objective Growth hormone (GH) deficiency is related to increased cardiovascular mortality. We studied clinical status, concentration of amino-terminal-pro B-type natriuretic-peptide (NT-proBNP) and echocardiographic parameters during long-term GH replacement (GH-R). Methods Fifty-one patients (29 females), 45.9 ± 11.3 years (mean ± s.d.), median follow-up 36.2 months, echocardiography and laboratory determinations initially and at 12-months intervals. Results At the last follow-up (last observation carried forward) (LFU (LOCF)) insulin-like growth-factor-1 standard deviation score (IGF-1 SDS) was ±1 in 92% of the patients. The median NT-proBNP declined significantly and stabilized (−40.5%) at LFU (LOCF) due to patients with a basal NT-proBNP >125 ng/L (indicative of heart failure). The basal NT-proBNP and the final IGF-1 SDS were significant predictors of the NT-proBNP at LFU (LOCF). Initially left ventricular enddiastolic diameter (LVEDD), left ventricular posterior wall diameter (LVPWD) and ejection fraction (EF) were normal, while interventricular septum diameter (IVSD) and left ventricular mass index (LVMi) were slightly increased. LVPWD and IVSD had significantly declined by year three. The LVMi was moderately to severely abnormal in 37.3 and 52.0% of patients initially and at LFU (LOCF). At LFU (LOCF) LVMi and IGF-1 were significantly correlated in the 14 male patients of this subgroup. Conclusion Long-term GH-R of GHD positively affected ISVD and LVPWD. In a subgroup of patients with severe GHD, LVMi increased concomitantly to the decline in NT-proBNP and this was positively correlated to the final IGF-1 concentration. Whether this observation indicates a positive development in a structurally altered heart muscle (reversal of adverse remodelling) or poses a future risk for heart failure needs further follow-up.

Bone and body composition analyses by DXA in adults with GH deficiency: effects of long-term replacement therapy

“…In fact, a lower fracture incidence was recorded in GHD patients receiving growth hormone as compared with those who did not, even after adjustment for confounding factors in multivariable analysis [9]. Equally, as extensively discussed [10], GH replacement therapy bene ts body composition by enhancing lean mass [11][12][13] as well as heart function by improving echocardiographic morphology [14][15].…”

Adult growth hormone deficiency: clinical advances and approaches to improve adherence

“…Studies have also shown that rhGH therapy improved several cardiovascular markers, including lipids, visceral fat, and some echocardiographic parameters, including interventricular septum diameter, left ventricular posterior wall-diameter and left ventricular mass index [65][66][67], whereas discontinuing long-term rhGH therapy may worsen total-and LDL-cholesterol levels [52] and diastolic blood pressure [68]. Other surrogate cardiovascular risk markers have been shown to improve with rhGH therapy, including C-reactive protein [69,70], adipsin [71], pro-inflammatory cytokines such as tumor-necrosis factor alpha [72], pregnancy-associated plasma protein A [73], lipid peroxidation [74] decreased, and markers of endothelial dysfunction [75].…”

Growth Hormone Deficiency: Is It Just a Problem of Growth Impairment? Part I

“…Therefore, and given the positive effects of GH on the heart, it is likely that GH treatment may be useful in patients with heart failure, even if they are not GHD. Many recent studies support such a possibility, and the treatment with GH has been proposed and carried out with very good results in untreated GHD children and adults with heart failure and also in patients suffering this affectation even though they are not GHD [109][110][111][112][113][114][115][116][117], although there are studies suggesting that this GH therapy only provides positive results in GHD patients [118].…”