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Improvement of Growth Hormone Deficiency in Patients with Primary Hyperparathyroidism after Parathyroidectomy: Results of a Prospective Study

Department of Endocrinology and Metabolism (E.C., M.Ga., F.B., L.G., M.Ge., C.M., A.P., E.M.), University of Pisa, 56124 Pisa, Italy; Division of Endocrinology (M.P.), University of Turin, Turin, Italy; and Division of Endocrinology (L.B.), University of Insubria, 21100 Varese, Italy

Address all correspondence and requests for reprints to: Prof. Enio Martino, Dipartimento di Endocrinologia e Metabolismo, Università di Pisa, Ospedale Cisanello, Via Paradisa, 2 56124, Pisa, Italy. E-mail: e.martino{at}endoc.med.unipi.it.

GH secretion is impaired in most patients with primary hyperparathyroidism (PHP), although the secretion of the other anterior pituitary hormones is unaffected. However, whether restoration of euparathyroidism is associated with reversal of GH deficiency in PHP patients is not known. To address this issue, we studied 30 consecutive patients with PHP due to a single parathyroid adenoma before and after parathyroidectomy. GH secretion was evaluated by peak serum GH after the maximal GHRH + arginine (Arg) stimulation test. A group of 35 age- and sex-matched normal subjects served as controls. Serum IGF-I concentration was below the normal age- corrected values in six of 30 patients before surgery and in four of 30 patients after parathyroidectomy (P = not significant). Mean serum peak GH values after the GHRH + Arg test were 17.5 ± 2.8 µg/liter before surgery and 23.8 ± 2.5 µg /liter after surgery (P = 0.0008). The GH response to the GHRH + Arg test was reduced in 20 (67%) and normal in 10 (33%) of 30 PHP patients at baseline; after surgery, 22 of 30 (73%) PHP patients had a normal GH response to the GHRH + Arg test, and only eight (27%) had an impaired GH secretion (P < 0.02).

In conclusion, this study confirms that GH secretion is impaired in PHP patients and indicates that it is reversed in many patients after parathyroidectomy.

Accordingly, GH deficiency in PHP patients must be considered a functional phenomenon for which GH therapy is not recommended.

This work was partially supported by grants from the University of Pisa (Fondi di Ateneo) and Ministero dell’Istruzione, dell’Universita e della Ricerca, Rome (to E.M. and M.G.), and from the University of Insubria at Varese (to L.B.).

Abbreviations: Arg, Arginine; PHP, primary hyperparathyroidism.

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