Childhood-Onset GH Deficiency versus Adult-Onset GH Deficiency: Relevant Differences Regarding Insulin Sensitivity

Abstract

Introduction: The results of the studies on the pattern of insulin sensitivity (IS) are contradictory in patients with GH deficiency (GHD); however, the interference of the GHD onset stage, childhood or adulthood in the IS has not been assessed by euglycemic hyperinsulinemic clamp (EHC), a gold-standard method for the assessment of insulin sensitivity. Materials and Methods: In a prospective cross-sectional study, we assessed IS and body composition in 17 adults with hypopituitarism without GH replacement, ten with childhood-onset (COGHD) and seven with adulthood-onset (AOGHD) and compared them to paired control groups. Results: COGHD presented higher IS (p = 0.0395) and a similar percentage of fat mass (PFM) to AOGHD. COGHD showed higher IS than the control group (0.0235), despite a higher PFM (0.0022). No differences were found between AODGH and the control group. In AOGHD and the control group, IS was negatively correlated with PFM (rs: −0.8214, p = 0.0234 and rs: −0.3639, p < 0.0344), while this correlation was not observed with COGHD (rs: −0.1152, p = 0.7514). Conclusions: Despite the higher PFM, patients with COGHD were more sensitive to insulin than paired healthy individuals, while patients with AOGHD showed similar IS compared to controls. The lack of GH early in life could modify the metabolic characteristics of tissues related to the glucose metabolism, inducing beneficial effects on IS that persist into adulthood. Thus, the glycometabolic findings in patients with COGHD seems to be not applicable to AOGHD.

Growth hormone deficiency in adults: Diagnosis and treatment

“…Međutim, te promene su blage i vezane za prve mesece terapije, posle se ti parametri vraćaju na bazalne vrednosti i dolazi do poboljšanja dugoročne glikoregulacije zahvaljujući poboljšanju telesnog sastava (redukcija abdominalnog masnog tkiva). Višegodišnje studije praćenja efekata terapije GH na preko 15.000 pacijenata, pokazuju da je rizik od razvoja dijabetes melitusa (Diabetes Mellitus, DM) blago povećan i da sklonost za DM imaju starije osobe i osobe sa većim BMI i lošim lipidnim profilom 23,30 . Kontraindikacije za primenu GH su: aktivna maligna bolest, manifestna šećerna bolest, teška oboljenja jetre i bubrega, benigna intrakranijalna hipertenzija, teška psihička oboljenja.…”

“…However, these changes are mild and are related to the first months of therapy; afterward, these parameters return to baseline values and there is an improvement in long-term glycemic control due to changes in body composition (reduction in abdominal fat). Long-term studies monitoring the effects of GH therapy on over 15,000 patients show that the risk of developing diabetes mellitus (DM) is slightly increased, with older individuals and those with higher BMI and poor lipid profiles being more predisposed 23,30 . Contraindications for GH therapy include: active malignant disease, manifest diabetes mellitus, severe liver and kidney diseases, benign intracranial hypertension, and severe psychiatric disorders.…”