Cardiovascular Risk in Adult Patients With Growth Hormone (GH) Deficiency and Following Substitution With GH—An Update

Gazzaruso, Carmine; Gola, M; Karamouzis, Ioannis; Giubbini, Raffaele; Giustina, Andrea

doi:10.1210/jc.2013-2394

Cited by 135 publications

(107 citation statements)

References 144 publications

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“…AGHD often have significant changes in their lipid profile with increased LDL, increased 564 triglycerides, decreased high-density lipoprotein (HDL) (the latter observed only in women), with no 565 differences in lipoprotein (a) [139]. GH replacement positively reverses this negative lipid profile in…”

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confidence: 99%

Growth Hormone (GH) and Cardiovascular system

Caicedo¹,

Díaz²,

Devesa³

et al. 2017

Preprint

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This review describes the positive effects of growth hormone on the cardiovascular 13 system. We analyze why the vascular endothelium is a real internal secretion gland, whose 14 inflammation is the first step for developing atherosclerosis, as well as the mechanisms by which 15GH acts on the vascular endothelium improving its dysfunction. We also report how GH acts on 16 coronary arterial disease and heart failure, and on peripheral arterial disease inducing the 17 generation of new collateral vessels able to bypass a major artery occlusion. We include some 18 preliminary data from a trial in which GH or placebo is given to elder people suffering from critical 21We also analyze how Klotho may have strong relationships with GH, inducing, after being released 22 from the damaged vascular endothelium, the pituitary secretion of GH to repair the damaged tissue. 23Lastly, we show how GH induces wound healing by increasing the blood flow to the ischemic tissue. 24In summary, we postulate that short-time GH administration is useful for treating cardiovascular 25 diseases. 26

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confidence: 99%

Growth Hormone (GH) and Cardiovascular system

Caicedo¹,

Díaz²,

Devesa³

et al. 2017

Preprint

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“…A Dutch cohort of healthy subjects of resembling age demonstrated a higher increase in diastolic blood pressure during 6 years of follow-up (0.8 mmHg/year) (26). To date, only three studies have reported on the risk or incidence of CVDs in GH-treated adult patients with more than 2 years of follow-up (9,10,11,30). The assumed increased risk for CVDs diminished and even a decreased risk for CVDs was found in one (11).…”

Section: Discussionmentioning

confidence: 99%

Effect of long-term GH replacement therapy on cardiovascular outcomes in isolated GH deficiency compared with multiple pituitary hormone deficiencies: a sub-analysis from the Dutch National Registry of Growth Hormone Treatment in Adults

Bunderen

Dries

Heymans

et al. 2014

European Journal of Endocrinology

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Objective: Isolated GH deficiency (IGHD) could provide a model to investigate the influence of GH deficiency per se and the effect of GH replacement therapy without the influence from other pituitary hormone deficiencies or their treatment. The aim of this study is to address the questions about differences between IGHD and multiple pituitary hormone deficiencies (MPHDs) in clinical presentation and in responsiveness to GH treatment. Design: A nationwide surveillance study was carried out to describe the difference in the clinical presentation and responsiveness to GH treatment of patients with IGHD and MPHDs. Methods: The Dutch National Registry of GH Treatment in Adults was founded in 1998 to gain more insight into long-term efficacy and safety of GH therapy. Out of 2891 enrolled patients, 266 patients with IGHD at the start of GH treatment were identified and compared with 310 patients with MPHDs. Cardiovascular indices will be investigated at baseline and during long-term follow-up, including body composition, lipid profile, glucose metabolism, blood pressure, and morbidity. Results: Patients with IGHD and MPHDs were demonstrated to be different entities at clinical presentation. Metabolically, patients with MPHDs had a larger waist circumference, lower HDL cholesterol level, and higher triglyceride level. The effect of GH treatment was comparable between patient groups. GH seems to protect against rising lipid levels and blood pressure, even after excluding patients using corresponding concomitant medication. The risk for cardiovascular disease or diabetes mellitus during follow-up was not different between patients with IGHD and MPHDs. Conclusions: Patients with IGHD had a less impaired metabolic profile than patients with MPHDs at baseline. Influence of other pituitary hormone replacement therapies on the effect of GH treatment is not demonstrated.

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“…During follow-up, despite an increase in waist circumference (especially in previous NFPA), the positive effect of GH treatment on lipid profile was evident in both groups. These positive effects of long-term GH treatment in all GHD patients on lipid profile have been demonstrated before, except for triglycerides for which results remain inconclusive (34,35), also in patients with GHD after acromegaly positive effects have been reported (17,20,28). However, most studies do not or are unable to take into account the use of lipid-lowering medication.…”

Section: European Journal Of Endocrinologymentioning

confidence: 91%

Effect of long-term GH replacement therapy on cardiovascular outcomes in GH-deficient patients previously treated for acromegaly: a sub-analysis from the Dutch National Registry of Growth Hormone Treatment in Adults

Bunderen

Varsseveld

Heymans

et al. 2014

European Journal of Endocrinology

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Objective: The effect of GH deficiency (GHD) on the metabolic profile of acromegaly patients is unclear in patients previously treated for acromegaly, as are the efficacy and safety of GH treatment in this particular group. The aim of the study is to describe the characteristics of patients with severe GHD who were previously treated for acromegaly, and to investigate the effects of long-term GH treatment on cardiovascular risk factors and morbidity, compared with patients who were treated for a nonfunctioning pituitary adenoma (NFPA). Design: A nationwide surveillance study. Methods: Sixty-five patients from the Dutch National Registry of Growth Hormone Treatment in Adults with previous acromegaly were compared with 778 patients with previous NFPA. Cardiovascular indices, including body composition, lipid profile, glucose metabolism, blood pressure, and morbidity were investigated. Results: GHD patients with previous acromegaly had an unfavorable metabolic profile comparable with or more than GHD patients with previous NFPA. GH treatment led to improvement of the lipid profile in both groups, also after excluding patients using lipid-lowering medication. In patients with previous acromegaly, HbA1c levels increased more than in patients with previous NFPA (estimate 0.03, 95% CI 0.002-0.06, PZ0.04). The risk for developing cardiovascular diseases was not different between the groups. Conclusions: The patients with GHD after previous acromegaly have an unfavorable metabolic profile comparable with patients with GHD after previous NFPA. In both groups, the lipid profile improves during GH treatment. Changes in glucose metabolism should be monitored closely. GH treatment in patients with GHD previously treated for acromegaly had no deleterious effect on cardiovascular morbidity.

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Cardiovascular Risk in Adult Patients With Growth Hormone (GH) Deficiency and Following Substitution With GH—An Update

Cited by 135 publications

References 144 publications

Growth Hormone (GH) and Cardiovascular system

Growth Hormone (GH) and Cardiovascular system

Effect of long-term GH replacement therapy on cardiovascular outcomes in isolated GH deficiency compared with multiple pituitary hormone deficiencies: a sub-analysis from the Dutch National Registry of Growth Hormone Treatment in Adults

Effect of long-term GH replacement therapy on cardiovascular outcomes in GH-deficient patients previously treated for acromegaly: a sub-analysis from the Dutch National Registry of Growth Hormone Treatment in Adults

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