Comparative results of a 4-year study on cardiovascular parameters, lipid metabolism, body composition and bone mass between untreated and treated adult growth hormone deficient patients

Fideleff, Hugo; Boquete, Hugo; Stalldecker, Graciela; Giaccio, Ana; Sobrado, P

doi:10.1016/j.ghir.2008.01.002

Cited by 29 publications

(21 citation statements)

References 34 publications

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“…By contrast, the effects on LBM remained the same after 2 years with BIA and increased further by 0.5 kg with DXA (PZ0.018) (25). One study comparing 48 patients on GH for 4 years with 23 GHD patients not treated with GH showed more effect in the GH-treated group on FM (K1.8 vs K0.2%) and LBM (K1.5 vs 0.6%), although the difference was not significant (54).…”

Section: Influence Of Baseline and Other Variables On Effect Of Gh Thmentioning

confidence: 95%

Cardiovascular risk factors in hypopituitary GH-deficient adults

Verhelst¹,

Abs²

2009

European Journal of Endocrinology

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Design: Data on lipids, body composition, and blood pressure (BP) from all published KIMS papers are summarized and compared with a literature review. Results: KIMS data confirm and extend previous research showing that adults with GH deficiency (GHD) have an adverse cardiovascular risk profile. GHD patients have high levels of dyslipidemia, elevated body mass index, unfavorable waist-to-hip ratio and body composition, and a high risk of hypertension. These abnormalities are likely to explain the increased cardiovascular mortality observed in patients with hypopituitarism. When given GH replacement therapy, an improvement is seen in KIMS as well as earlier studies for lipid profile, body composition, and BP. The added value of the different KIMS papers over previous research is that KIMS involves a much larger number of patients, that lipid concentrations and IGF1 are measured in a single central laboratory, and that the effects of GH replacement therapy can be followed longer than the duration of earlier trials. By the large number of patients, KIMS gives insight into the effects of GH in different patients' subgroups such as elderly patients, patients with idiopathic GHD, patients with craniopharyngioma, patients after irradiation, and so on. In addition, KIMS has made it possible to calculate more exactly the influence of baseline parameters on these cardiovascular risk parameters and their response to GH. Conclusions: Taken together, data from KIMS confirm earlier knowledge about the important benefits of GH replacement therapy, but also on the use of GH in specific subgroups such as isolated GHD, patients above 65 years, and patients after irradiation. No subgroup yet has been identified as not responding well to GH.

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Section: Influence Of Baseline and Other Variables On Effect Of Gh Thmentioning

confidence: 95%

Cardiovascular risk factors in hypopituitary GH-deficient adults

Verhelst¹,

Abs²

2009

European Journal of Endocrinology

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“…GH replacement is usually associated with a neutral effect on blood pressure (BP) (38); the antinatriuretic and possible chronotropic actions of GH are offset by vasodilation arising from increased generation of endothelial nitrous oxide. In studies where changes have been reported, these tend to reflect improvements in diastolic BP (27,36,39,51). These findings may be less apparent in older patients.…”

Section: Other Cardiovascular Risk Factorsmentioning

confidence: 97%

“…Initially, there was concern that GH replacement would increase this prevalence further by increasing insulin resistance and hence diabetes rates. Although in the short term fasting plasma glucose may rise on commencing GH replacement (53), improvements in LBM and WHR offset these changes and in the longterm there is no rise in HbA1c (51,52) or plasma glucose (54). After 1 year of GH replacement, normalisation of insulin sensitivity and plasma glucose diurnal variation are seen (55).…”

Section: Other Cardiovascular Risk Factorsmentioning

confidence: 99%

“…Severe childhood and adult-onset GHD have been consistently associated with low BMD and BMC, which improve with GH replacement (29,51,59). However, mild childhood-onset GHD (peak GH 3-11.8 mg/l on provocation testing) appears to be associated with normal BMD (12) and improvements in BMC have been seen with what could be considered sub-therapeutic IGF1 levels (57).…”

Section: Bonementioning

confidence: 99%

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Adult GH deficiency throughout lifetime

Thomas

Monson

2009

European Journal of Endocrinology

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It is now accepted that adults with severe GH deficiency (GHD) demonstrate impaired physical and psychological well-being and may benefit from replacement with recombinant human GH. Postmarketing surveillance surveys, such as the Pfizer International Metabolic Database (KIMS), were initially set-up to provide safety data on long-term treatment but have the added benefit of providing ongoing observational data on the effect of GH replacement on body composition, lipid and glucose status, hypertension, bone density and quality of life. These data demonstrate that although GHD has clinical impact at all ages, the individual consequences of this condition may take on greater significance at different stages in life. At all ages, accurate, safe diagnosis and appropriate GH dosing are necessary to provide the individual with the best possible outcome.

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“…Endothelial dysfunction and increased intimal-medial thickness (IMT) have also been described in these patients [5]. Until now, despite discrepancies among studies, growth hormone deficiency is the most well-known risk factor [4,6,7] of cardiovascular disease. However, this factor alone does little to explain all the phenomena that occur in hypopituitarism.…”

Section: Introductionmentioning

confidence: 99%

Carotid atheromatic plaque is commonly associated with hypopituitary men

et al. 2010

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Hypopituitarism increases the risks of many cardiovascular conditions and therefore, patients with this disease are more prone to cardiovascular disease. To our knowledge, there have been few studies on carotid artery plaque in male patients with hypopituitarism in assessing cardiovascular risks. The aim of this study was to specifically compare carotid artery plaque while examining other major cardiovascular risk factors between male patients with hypopituitarism and control subjects. Forty male patients aged 30-70 years with hypopituitarism and forty age, sex-matched control subjects were recruited at the Yonsei University Severance Hospital, Seoul, Korea. Carotid intima media thickness (IMT) and atheromatous plaque, anthropometry, lipid profile, and pituitary hormones were assessed. Atheromatous plaque in the carotid arteries was observed more frequently in patients with hypopituitarism than age-and sex-matched control subjects (59.5% vs. 2.5%, P \ 0.01) without differences of carotid IMTs. Patients with hypopituitarism also exhibited higher waist circumference, waist to hip ratio, total cholesterol and LDL cholesterol than control subjects. In subgroup analysis in male patients with hypopituitarism including GH deficiency, lower testosterone levels were associated with higher waist circumference (r = 0.446, P = 0.033).In conclusion, hypopituitary males exhibit an increased incidence of carotid artery plaque without differences of carotid IMTs, central obesity and higher total cholesterol level. Lower testosterone levels were associated with central obesity-a strong component of a metabolic syndrome, and unsubstituted testosterone deficiency might be an important cardiovascular risk factor in patients with hypopituitarism.

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Comparative results of a 4-year study on cardiovascular parameters, lipid metabolism, body composition and bone mass between untreated and treated adult growth hormone deficient patients

Cited by 29 publications

References 34 publications

Cardiovascular risk factors in hypopituitary GH-deficient adults

Cardiovascular risk factors in hypopituitary GH-deficient adults

Adult GH deficiency throughout lifetime

Carotid atheromatic plaque is commonly associated with hypopituitary men

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