This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Chrisoulidou, A. Articles by Johnston, D. G. Search for Related Content PubMed PubMed Citation Articles by Chrisoulidou, A. Articles by Johnston, D. G. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Hazardous Substances DB POTASSIUM

Effects of 7 Years of Growth Hormone Replacement Therapy in Hypopituitary Adults¹

Section of Endocrinology and Metabolic Medicine; Departments of Clinical Physics, Chemical Pathology, and Cardiology; and Division of Biomedical Sciences, Imperial College School of Medicine, St. Mary’s Hospital, London, United Kingdom W2 1NY; and Medical Research Council Cyclotron Unit, Hammersmith Hospital, London, United Kingdom

Address all correspondence and requests for reprints to: Dr. A. Chrisoulidou, Section of Endocrinology and Metabolic Medicine, Imperial College School of Medicine, St. Mary’s Hospital, London, United Kingdom W2 1NY.

Short-term studies of GH replacement in adult hypopituitarism have usually demonstrated beneficial effects on body composition and circulating lipids, with neutral or occasionally adverse effects on glucose tolerance. Fasting hyperinsulinemia has been reported. GH effects on cardiac function have been variable. The effects of long-term GH therapy, taking into account the consequences of increasing age, are not fully known. Thirty-three hypopituitary, initially middle-aged adults were studied over a 7-yr period; 12 patients took GH therapy (mean, 0.7 mg daily) continuously (group A); 11 took GH for only 6–18 months, a minimum of 5 yr previously (group B); and 10 patients never received GH therapy (group C). Other pituitary replacement was maintained. Effects on anthropometry, body composition (by bioimpedance analysis, total body potassium, and dual energy x-ray absorptiometry), circulating lipids, glucose and insulin concentrations, cardiac 2-dimensional and Doppler echocardiography, and exercise tolerance were assessed before and after the treatment period. Continuous GH therapy had no significant effect on body weight, but it prevented the increase in waist circumference and waist to hip ratio that occurred in the patients without GH substitution (waist to hip ratio, group A, 0.87 ± 0.08 at baseline, 0.85 ± 0.09 at 7 yr; group B, 0.89 ± 0.11 at baseline, 0.94 ± 0.11 at 7 yr; P < 0.005 for GH effect; group C, 0.87 ± 0.10 at baseline, 0.92 ± 0.10 at 7 yr; P < 0.005 for GH effect). A GH-induced decrease in subscapular skinfold thickness was also observed. By bioimpedance analysis, GH therapy caused an increase in total body water and fat-free mass, and a decrease in the percent body fat. Although changes occurred with time in all groups, no significant additional GH therapy effects were observed on glucose tolerance, insulin concentrations, lipid levels, cardiac dimensions, echocardiographic diastolic function, or exercise tolerance. In conclusion, prolonged GH substitution in middle-aged hypopituitary adults causes a sustained improvement in body composition. Other benefits, e.g. on lipid levels and exercise tolerance, were not apparent at 7 yr when comparisons were made with GH-untreated hypopituitary controls. Potentially adverse effects on glucose tolerance and insulinemia did not develop with prolonged GH therapy.

This article has been cited by other articles:

				C Joaquin, E Aguilera, M L Granada, M C Pastor, I Salinas, N Alonso, and A Sanmarti Effects of GH treatment in GH-deficient adults on adiponectin, leptin and pregnancy-associated plasma protein-A. Eur. J. Endocrinol., April 1, 2008; 158(4): 483 - 490. [Abstract] [Full Text] [PDF]

				A. A van der Klaauw, N. R Biermasz, E. J M Feskens, M. B Bos, J. W A Smit, F. Roelfsema, E. P M Corssmit, H. Pijl, J. A Romijn, and A. M Pereira The prevalence of the metabolic syndrome is increased in patients with GH deficiency, irrespective of long-term substitution with recombinant human GH Eur. J. Endocrinol., April 1, 2007; 156(4): 455 - 462. [Abstract] [Full Text] [PDF]

				G. Gotherstrom, B.-A. Bengtsson, I. Bosaeus, G. Johannsson, and J. Svensson A 10-Year, Prospective Study of the Metabolic Effects of Growth Hormone Replacement in Adults J. Clin. Endocrinol. Metab., April 1, 2007; 92(4): 1442 - 1445. [Abstract] [Full Text] [PDF]

				A A van der Klaauw, J A Romijn, N R Biermasz, J W A Smit, J van Doorn, O M Dekkers, F Roelfsema, and A M Pereira Sustained effects of recombinant GH replacement after 7 years of treatment in adults with GH deficiency. Eur. J. Endocrinol., November 1, 2006; 155(5): 701 - 708. [Abstract] [Full Text] [PDF]

				L. J. Woodhouse, A. Mukherjee, S. M. Shalet, and S. Ezzat The Influence of Growth Hormone Status on Physical Impairments, Functional Limitations, and Health-Related Quality of Life in Adults Endocr. Rev., May 1, 2006; 27(3): 287 - 317. [Abstract] [Full Text] [PDF]

				M. E. Molitch, D. R. Clemmons, S. Malozowski, G. R. Merriam, S. M. Shalet, M. L. Vance, and for The Endocrine Society's Clinical Guidelines Su Evaluation and Treatment of Adult Growth Hormone Deficiency: An Endocrine Society Clinical Practice Guideline J. Clin. Endocrinol. Metab., May 1, 2006; 91(5): 1621 - 1634. [Abstract] [Full Text] [PDF]

				J. Bollerslev, J. Hallen, K. J Fougner, A. P. Jorgensen, C. Kristo, H. Fagertun, O. Gudmundsen, P. Burman, and T. Schreiner Low-dose GH improves exercise capacity in adults with GH deficiency: effects of a 22-month placebo-controlled, crossover trial Eur. J. Endocrinol., September 1, 2005; 153(3): 379 - 387. [Abstract] [Full Text] [PDF]

				M. Gola, S. Bonadonna, M. Doga, and A. Giustina Growth Hormone and Cardiovascular Risk Factors J. Clin. Endocrinol. Metab., March 1, 2005; 90(3): 1864 - 1870. [Abstract] [Full Text] [PDF]

				T. B. Twickler, M. J. M. Cramer, G. M. Dallinga-Thie, M. J. Chapman, D. W. Erkelens, and H. P. F. Koppeschaar Adult-Onset Growth Hormone Deficiency: Relation of Postprandial Dyslipidemia to Premature Atherosclerosis J. Clin. Endocrinol. Metab., June 1, 2003; 88(6): 2479 - 2488. [Full Text] [PDF]

				W. L. Isley Growth Hormone Therapy for Adults: Not Ready for Prime Time? Ann Intern Med, August 6, 2002; 137(3): 190 - 196. [Abstract] [Full Text] [PDF]

				S. Ezzat, S. Fear, R.-C. Gaillard, C. Gayle, H. Landy, S. Marcovitz, T. Mattioni, S. Nussey, A. Rees, and E. Svanberg Gender-Specific Responses of Lean Body Composition and Non-Gender-Specific Cardiac Function Improvement after GH Replacement in GH-Deficient Adults J. Clin. Endocrinol. Metab., June 1, 2002; 87(6): 2725 - 2733. [Abstract] [Full Text] [PDF]

				J. Svensson, J. Fowelin, K. Landin, B.-A. Bengtsson, and J.-O. Johansson Effects of Seven Years of GH-Replacement Therapy on Insulin Sensitivity in GH-Deficient Adults J. Clin. Endocrinol. Metab., May 1, 2002; 87(5): 2121 - 2127. [Abstract] [Full Text] [PDF]

				A. F. Attanasio, P. C. Bates, K. K. Y. Ho, S. M. Webb, R. J. Ross, C. J. Strasburger, R. Bouillon, B. Crowe, K. Selander, D. Valle, et al. Human Growth Hormone Replacement in Adult Hypopituitary Patients: Long-Term Effects on Body Composition and Lipid Status--3-Year Results from the HypoCCS Database J. Clin. Endocrinol. Metab., April 1, 2002; 87(4): 1600 - 1606. [Abstract] [Full Text] [PDF]

				M. E. Molitch Diagnosis of GH Deficiency in Adults--How Good Do the Criteria Need to Be? J. Clin. Endocrinol. Metab., February 1, 2002; 87(2): 473 - 476. [Full Text] [PDF]