Sustained reduction in circulating cholesterol in adult hypopituitary patients given low dose titrated growth hormone replacement therapy: a two year study

Florakis, Dimos; Hung, Vivian Wing‐Yin; Kaltsas, Gregory; Coyte, D.; Jenkins, Paul J.; Chew, Shern L.; Grossman, Ashley; Besser, G. M.; Monson, John P.

doi:10.1046/j.1365-2265.2000.01108.x

Cited by 64 publications

(62 citation statements)

References 34 publications

(62 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This contrasts with a number of previous findings suggesting that GH replacement has different effects in different subgroups, such as age of onset (43) or gender (50). The homogeneity of therapeutic effects of GH has been shown before for elderly patients (51) and the additive effect of GH, apart from lipid-lowering drugs has also been demonstrated (52). There was a clear trend of the effects of GH treatment to be greater after 2 years than after 1 year and be most marked in patients with the most pronounced hypercholesterolaemia at baseline.…”

Section: Discussioncontrasting

confidence: 55%

Determinants of cardiovascular risk in 2589 hypopituitary GH-deficient adults – a KIMS database analysis

et al. 2006

View full text Add to dashboard Cite

Objective: The aim of the present study was to clarify the relationship between GH deficiency (GHD) and some cardiovascular risk factors and to analyse the effect of GH replacement therapy in a large number of patients over a prolonged period of time. Design: Data for analysis were retrieved from KIMS (Pfizer International Metabolic Database). Serum concentrations of total cholesterol, high-density lipoprotein (HDL)-cholesterol, low-density lipoprotein (LDL)-cholesterol and triglycerides were obtained from 2589 patients at baseline and from 1206 patients after 1 and 2 years of GH replacement therapy. Body mass index (BMI), waist and hip, resting blood pressure and body composition were also measured. Results: At baseline, the unfavourable effects of GHD were most obvious in the lipid profile demonstrating elevated mean total and LDL-cholesterol, in the increased waist circumference and the elevated BMI. The cholesterol concentration, BMI and body composition were significantly adversely affected by a number of factors, including age, sex and the use of anti-epileptic drugs. The therapeutic effect of GH was essentially uniform across the whole population. GH replacement reduced significantly the mean total and LDL-cholesterol, the waist circumference and the fat mass and was maintained during 2 years. Conclusions: This analysis of a large number of patients confirmed that GHD adults present with an increased cardiovascular risk. The sustained improvement of the adverse lipid profile and body composition suggests that GH replacement therapy may reduce the risk of cardiovascular disease and the premature mortality seen in hypopituitary patients with untreated GHD.European Journal of Endocrinology 155 79-90

show abstract

Section: Discussioncontrasting

confidence: 55%

Determinants of cardiovascular risk in 2589 hypopituitary GH-deficient adults – a KIMS database analysis

et al. 2006

View full text Add to dashboard Cite

show abstract

“…In placebocontrolled studies, with a duration ranging from 1 week to 18 months, rhGH treatment was beneficial for lean and fat body mass, total and high-density lipoprotein (HDL) cholesterol levels and diastolic blood pressure (DBP), whereas rhGH negatively influenced plasma glucose and insulin levels (1). Long-term studies have revealed an increase in HDL cholesterol (2)(3)(4) and fasting glucose levels (3)(4)(5)(6), and a decrease in triglyceride (TG) levels (3,7). Systolic blood pressure (SBP) remained unchanged (3,7,8), whereas DBP decreased only in one study (8).…”

Section: Introductionmentioning

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

View full text Add to dashboard Cite

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

show abstract

“…Whereas patients with adrenal insufficiency may develop severe symptoms, GH deficiency (GHD) in adults typically presents with subtle signs. GHD may be clinically characterized by changes in body composition, impaired psychological well-being, reduction in bone mineral density, and metabolic alterations in lipids and insulin resistance, which GH replacement reverses (1)(2)(3). Under these circumstances, the diagnosis in a suspected patient is purely biochemical, based on an insufficient GH peak response in one or two stimulation tests, depending on the number of other pituitary hormone deficiencies (4).…”

Section: Introductionmentioning

confidence: 99%

Recovery of pituitary function in the late-postoperative phase after pituitary surgery: results of dynamic testing in patients with pituitary disease by insulin tolerance test 3 and 12 months after surgery

Berg¹,

Meinel²,

Lahner³

et al. 2010

European Journal of Endocrinology

View full text Add to dashboard Cite

The insulin tolerance test (ITT) is considered the gold standard for assessment of GH and ACTH reserve in patients with pituitary disease following pituitary surgery and is usually performed after 6-12 weeks. However, abnormal axes may not be completely recovered by then. The aim of this study was to evaluate dynamic testing 3 and 12 months after transsphenoidal pituitary surgery. Design and patients: Serial dynamic testing was performed in 36 patients (13 women, age 18-78) at 3 and 12 months after transsphenoidal surgery. Results: Compared with 3-month results, median GH peak levels during ITT after 12 months increased by 38% (P!0.05). In patients initially classified as GH deficiency (GHD), median GH peak increased after 12 months by 23% (P!0.05). At 3 and 12 months, 36% (13/36) and 47% (17/36) were GH sufficient respectively. Median cortisol peak levels after 12 months increased by 17% (P!0.01) compared with 3-month ITT. In ACTH-insufficient (AI) patients, peak cortisol levels increased significantly by 12% (P!0.05) at 12 months, and in ACTH-sufficient patients, peak cortisol levels increased significantly by 13% (P!0.05). At 12 months, there was recovery from AI in 11% of the patients, and recovery from GHD in 11% of patients. Conclusions: Serial dynamic testing results in a change in classification by ITT results in a relevant proportion of patients. Dynamic testing should be repeated during follow-up.

show abstract

Sustained reduction in circulating cholesterol in adult hypopituitary patients given low dose titrated growth hormone replacement therapy: a two year study

Cited by 64 publications

References 34 publications

Determinants of cardiovascular risk in 2589 hypopituitary GH-deficient adults – a KIMS database analysis

Determinants of cardiovascular risk in 2589 hypopituitary GH-deficient adults – a KIMS database analysis

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

Recovery of pituitary function in the late-postoperative phase after pituitary surgery: results of dynamic testing in patients with pituitary disease by insulin tolerance test 3 and 12 months after surgery

Contact Info

Product

Resources

About