Effects of 5 years of growth hormone (GH) replacement therapy on cardiac parameters and physical performance in adults with GH deficiency

Abstract

The purpose of this study was to evaluate the effects of 5 years of GH substitution on cardiac structure and function, physical work capacity and blood pressure levels in adults with GH deficiency (GHD). Fourteen patients were clinically assessed every 3 months for 5 years. Transthoracic echocardiography and exercise test were performed at baseline, 24, 48 and 60 months. Blood pressure (BP) was measured by means of ambulatory monitoring of blood pressure at baseline, 6, 12, 24 and 60 months. Left ventricular mass and its index increased progressively during the 5 years of GH substitution (P = 0.008 and 0.007, respectively). There were no significant changes in all others cardiac parameters evaluated. It was observed a significant improve in functional capacity (P < 0.001) and maximal oxygen uptake (P = 0.006) during the treatment. Diurnal systolic BP increased by 15 mmHg (P = 0.024) and diurnal diastolic BP by 4.5 mmHg (P = 0.037). There was no change in dirnal systolic pressure load but a considerable but non-statistically significant reduction in diurnal diastolic pressure load was observed during the study. During the night diastolic BP increased by 4 mmHg (P = 0.012) despite a substantial but non-statistically significant reduction in diastolic pressure load. We observed an increase in the proportion of persons with a non-physiological nocturnal fall (non-dippers) throughout the study (from 36.4% at baseline to 54.6% after 60 months of therapy). We concluded that 5 years of GH replacement promoted positive effects on exercise capacity and maximum oxygen uptake in spite of a modest increase in BP levels and left ventricular mass. Continuous monitoring is mandatory to arrive at further conclusions concerning the effects of GH substitution in adults on cardiovascular parameters with respect to possible unfavorable long term effects.

Cardiac function in growth hormone deficient patients before and after 1 year with replacement therapy: a magnetic resonance imaging study

“…In a recent study LVMI increased progressively from a mean of 72 g/m 2 at baseline to 103 g/m 2 after 5 years treatment (mean GH dose 0.64 mg/day) illustrating a potential risk of long-term treatment with GH doses in the higher range [30].…”

“…Since 2003 additional studies have been published [20][21][22][23][24][25][26][27][28][29][30]. Although the GH replacement doses in these newer studies are lower and less variable, conflicting result have still been reported [25,26].…”

“…Two patients had isolated GHD whereas the rest had insufficiencies in at least one of the other pituitary axes: Adrenal axis (n = 10, mean hydrocortisone dose 20 mg/day, range [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30], thyroid axis (n = 13, mean thyroxin dose 85 lg/day, range 50-150) and gonadal axis (n = 12, 5 females, 7 males). Two patients had been treated with GH during childhood for *3 years, and the treatment had been paused for 5 and 20 years before entering this study.…”

Chronic Endocrinopathies in Traumatic Brain Injury Disease

“…34 They found a progressive improvement in ventricular mass and improved exercise capacity and maximum oxygen uptake.…”

Wachstumshormontherapie im Erwachsenenalter: Eine aktuelle Übersicht

“…Diese Wachstumshormonwirkungen korrespondieren mit der von den betroff enen Patienten erlebten Verbesserung der physischen Leistungsfähigkeit [12,32,33].…”