Growth hormone deficiency and replacement in hypopituitary patients previously treated for acromegaly or Cushing's disease

Feldt‐Rasmussen, Ulla; Abs, Roger; Bengtsson, Bengt‐Åke; Bennmarker, Helge; Bramnert, Margareta; Hernberg‐Ståhl, Elizabeth; Monson, John P.; Westberg, Björn; Wilton, Patrick; Wüster, Christian

doi:10.1530/eje.0.1460067

Cited by 79 publications

(96 citation statements)

References 32 publications

(14 reference statements)

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“…Furthermore, we confirmed that there are no significant differences in terms of metabolic parameters between cured acromegalic patients and matched adults with other pituitary diseases with severe GHD, in agreement with previous observation (22). On the contrary, a recent study has reported a more impaired cardiovascular risk profile in ten GHD patients with previous acromegaly as compared with other GHD patients (23).…”

Section: Discussionsupporting

confidence: 92%

Prevalence of GH deficiency in cured acromegalic patients: impact of different previous treatments

Ronchi¹,

Giavoli²,

Ferrante³

et al. 2009

European Journal of Endocrinology

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Objective: Radiotherapy (RT) for pituitary adenomas, including GH-secreting ones, frequently leads to GH deficiency (GHD). Data on the effects of surgery alone (S) on dynamic GH secretion are limited. The aim of the study was to investigate the occurrence of GHD in acromegalic patients treated with different therapeutic options. Design and methods: Fifty-six patients in remission from acromegaly, (33 F & 23 M, age: 54G13 years, body mass index (BMI): 28.4G4.1 kg/m 2 , 21 with adequately substituted pituitary deficiencies) treated by S alone (nZ33, group 1) or followed by RT (nZ23, group 2), were investigated for GHD by GHRH plus arginine testing, using BMI-adjusted cut-offs. Several metabolic and cardiovascular parameters (waist circumference, body fat percentage, blood pressure, fasting and post-oral glucose tolerance test glucose, HbA1c, insulin resistance and lipid profile) were evaluated in all the patients and 28 control subjects with known diagnosis of GHD. Results: Serum GH peak after challenge was 8.0G9.7 mg/l, without any correlation with post-glucose GH nadir and IGF-1 levels. The GH response indicated severe GHD in 34 patients (61%) and partial GHD in 15 patients (27%). IGF-1 were below the normal range in 14 patients (25%). The frequency of GHD was similar in the two treatment groups (54% in group 1 and 70% in group 2). No significant differences in metabolic parameters were observed between acromegalic patients and controls with GHD. Conclusions: Severe GHD may occur in about 60% of patients treated for acromegaly, even when cured after S alone. Thus, a stimulation test (i.e. GHRH plus arginine) is recommended in all cured acromegalic patients, independently from previous treatment.

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Section: Discussionsupporting

confidence: 92%

Prevalence of GH deficiency in cured acromegalic patients: impact of different previous treatments

Ronchi¹,

Giavoli²,

Ferrante³

et al. 2009

European Journal of Endocrinology

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“…However, it should be noted that in this study the radiotherapy patients had a longer period of GHD prior to replacement (11.5 vs 4.7 years) and that those treated with radiotherapy have a tendency towards most severe disease. GHD secondary to Cushing's disease and acromegaly is not associated with baseline differences in body composition when compared with other causes of GHD (34).…”

Section: Clinical Characteristics Of the Hypopituitary Gh Deficient mentioning

confidence: 81%

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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“…Patients with Cushing's disease are known to have a high prevalence of cardiovascular risk factors, even after successful long-term cure of Cushing's disease (20). On the other hand, FeldtRasmussen et al found no differences in WH ratio, BMI, TG, and total, LDL and HDL cholesterol levels between patients with GHD due to previous treatment for Cushing's disease compared with patients with GHD due to other aetiologies (21). In our limited number of patients, we were unable to demonstrate differences in the prevalence of the MS between patients treated for Cushing's disease or acromegaly and patients treated for non-functioning pituitary adenomas, or between patients with producing pituitary adenomas compared with patients with non-functioning adenomas.…”

Section: Discussionmentioning

confidence: 99%

The prevalence of the metabolic syndrome is increased in patients with GH deficiency, irrespective of long-term substitution with recombinant human GH

Klaauw¹,

Biermasz²,

Feskens³

et al. 2007

eur j endocrinol

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Objectives: Many reports demonstrate improvements in cardiovascular risk factors during GH replacement (rhGH) in adult GH deficiency (GHD). However, it remains to be determined to what extent these changes translate into a reduction of increased cardiovascular morbidity and mortality. The aim of this study was to evaluate the effects of long-term rhGH replacement on the prevalence of the metabolic syndrome (MS). Design, settings, main outcome measures: The MS was scored by the National Cholesterol Education Program-Adult Treatment Panel III definition in 50 consecutive GHD patients (45G9 years of age), before and after 2 and 5 years of rhGH replacement, and the data of untreated patients were compared with the general population using data from a Dutch population-based study (nZ1062, 44G8 years of age). Results: Hypertriglyceridaemia (46.0 vs 18.5%, P!0.0001), hypertension (66.0 vs 35.5%, P!0.0001) and abdominal obesity (38.0 vs 23.4%, PZ0.0178) were more prevalent in untreated patients when compared with controls, resulting in a higher prevalence of the MS in patients (38.0 vs 15.7%, P!0.0001). During rhGH replacement at a mean dose of 0.5G0.2 mg/day resulting in IGF-I concentrations in the normal age-adjusted reference range, mean high-density lipoprotein cholesterol level increased compared with baseline (P!0.001). However, the prevalence of (components of) the MS did not change after 2 or 5 years of treatment with rhGH. Conclusion: In this study, the prevalence of the MS in patients with GHD is increased compared with healthy controls, irrespective of rhGH replacement. 156 455-462 European Journal of Endocrinology

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Growth hormone deficiency and replacement in hypopituitary patients previously treated for acromegaly or Cushing's disease

Cited by 79 publications

References 32 publications

Prevalence of GH deficiency in cured acromegalic patients: impact of different previous treatments

Prevalence of GH deficiency in cured acromegalic patients: impact of different previous treatments

Adult GH deficiency throughout lifetime

The prevalence of the metabolic syndrome is increased in patients with GH deficiency, irrespective of long-term substitution with recombinant human GH

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