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Departments of Molecular and Clinical Endocrinology and Oncology (A.Co., C.D.S., F.R., M.C.S., G.L.), Biomorphological and Functional Sciences, Nuclear Medicine Centre of the National Council of Research (A.Cu., W.A.), Internal Medicine I (L.S.), "Federico II" University of Naples, 80131 Naples, Italy; and Emergency Unit (S.S.), "S. Maria degli Incurabili" Hospital of Naples, Naples 80138, Italy
Address all correspondence and requests for reprints to: Annamaria Colao, M.D., Ph.D., Department of Molecular and Clinical Endocrinology and Oncology, "Federico II" University of Naples, via S. Pansini 5, 80131 Naples, Italy. E-mail: colao{at}unina.it.
Context: GH secretion and response to GH replacement are gender-related.
Objective: The objective of this study was to investigate the effects of GH deficiency (GHD) and replacement on the cardiovascular system according to gender.
Design: The design was open and prospective.
Setting: The study was conducted at a university hospital.
Subjects: Subjects included 36 severe adult-onset GHD patients (18 men, 20 women, aged < 45 yr); 36 gender-, age-, and body mass index-matched healthy subjects served as controls.
Interventions: Subjects received GH replacement at a median dose of 6.5 µg/kg·d in men and 7.7 µg/kg·d in women for 2 yr.
Main Outcome Measures: Homeostasis model assessment index, total to HDL cholesterol ratio, fibrinogen and C-reactive protein levels, left ventricular mass index, blood pressure, heart rate, diastolic filling, and systolic function at rest and at peak exercise and intima-media thickness (IMT) at common carotid arteries were measured.
Results: Basal prevalence and/or degree of insulin resistance, lipid alterations, compromised cardiac function, and IMT were similar in women and men. Diastolic dysfunction was more prevalent in men (61 vs. 25%, P = 0.036). After GH replacement, IGF-I levels normalized in all patients. Lipid profile, fibrinogen, and C-reactive protein levels normalized in all cases. The total to HDL ratio (P = 0.04) was higher in women than men. The homeostasis model assessment index persisted higher in GHD patients than controls and decreased only in GHD men (P = 0.017). Left ventricular mass index normalized during treatment in both women and men, abnormal diastolic function persisted in three women (P = 0.031), and abnormal systolic performance persisted in six women and one man (P = 0.13). IMT decreased similarly in women and men, persisting higher than in controls. Exercise performance normalized in all.
Conclusions: Two-year GH replacement has similar beneficial effects on cardiac and exercise performance and atherosclerosis in women and men with severe GHD.
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