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Institute of Endocrine Sciences (C.G., R.L., S.C., E.F., A.L., M.A., A.S., P.B.-P.), University of Milan, Ospedale Maggiore IRCCS, and Ospedale S. Giuseppe-Fatebenefratelli AFaR (M.A.), 20122 Milan, Italy
Address all correspondence and requests for reprints to: Paolo Beck-Peccoz, M.D., Institute of Endocrine Sciences, Ospedale Maggiore IRCCS, Pad. Granelli, Via F. Sforza, 35, 20122 Milan, Italy. E-mail: paolo.beckpeccoz{at}unimi.it.
The aim of the study was to evaluate the hypothalamus-pituitary-adrenal (HPA) axis in patients (nine males, three females; mean age ± SEM 51 ± 2 yr) with adult-onset GH deficiency (GHD) due to surgically treated pituitary tumors with preserved HPA function and without evidence of tumor recurrence before and during recombinant human (rh) GH replacement therapy (duration 31 ± 6 months). HPA function was assessed by urinary free cortisol and morning serum cortisol levels as well as cortisol responses to 1 µg ACTH test (n = 7 patients) or insulin tolerance test (n = 5 patients) before and during rhGH therapy, the cut-off for the diagnosis of hypoadrenalism being a cortisol peak less than 18 µg/dl (<500 nmol/liter) after stimulatory tests. Serum cortisol and urinary free cortisol levels were significantly lower on therapy than before [7.6 ± 0.8 vs. 11.5 ± 0.9 µg/dl (208 ± 22 vs. 317 ± 24 nmol/liter), P < 0.01, and 19.6 ± 2.5 vs. 32.2 ± 3.2 µg per 24 h (54 ± 7 vs. 89 ± 9 nmol per 24 h), P < 0.05, respectively], whereas no change in cortisol-binding globulin levels was observed. Cortisol peak after either ACTH test or insulin tolerance test was lower on rhGH therapy than before [15.9 ± 1.5 vs. 20.2 ± 1.1 µg/dl (437 ± 43 vs. 557 ± 31), P = 0.01, and 13.1 ± 2.6 vs. 20.4 ± 1.4 µg/dl (362 ± 71 vs. 564 ± 37 nmol/liter), P = 0.03, respectively]. Accordingly, central hypoadrenalism was detected in nine of 11 patients. In conclusion, low GH and IGF-I levels, likely enhancing the conversion of cortisone to cortisol, may mask a condition of central hypoadrenalism. Therefore, the reassessment of HPA function in GHD patients during rhGH therapy is mandatory.
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