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Improvement of Cardiac Performance and Cardiovascular Risk Factors in Children with GH Deficiency after Two Years of GH Replacement Therapy: An Observational, Open, Prospective, Case-Control Study

Departments of Pediatrics (M.S., V.E., V.F., A.U., D.C., S.M.), Internal Medicine I (L.S.), and Molecular and Clinical Endocrinology and Oncology (G.L, A.C.), University "Federico II" of Naples, 80131 Naples, Italy; and Department of Pediatrics (G.R.), Regional Hospital of Bolzano, 39100 Bolzano, Italy

Address all correspondence and requests for reprints to: Mariacarolina Salerno, M.D., Ph.D., Department of Pediatrics, Federico II University of Naples, Via S. Pansini 5, 80131 Naples, Italy. E-mail: salerno{at}unina.it.

Context: GH deficiency (GHD) in adults is associated with a cluster of cardiovascular risk factors that may contribute to an increased mortality for cardiovascular disease.

Objective: The aim of this study was to evaluate the effect of GHD and GH replacement therapy on cardiac performance, lipid profile, and insulin resistance in children.

Design: This was a 2-yr case-control prospective study.

Patients: Thirty children with GHD aged 9.3 ± 0.5 yr and 30 healthy matched controls were studied.

Intervention: Children were studied before and after 1 and 2 yr of GH replacement (GHD children) or no treatment (controls).

Main Outcome Measures: Lipid profile, serum insulin levels, homeostasis model of assessment (HOMA) index, and left ventricular (LV) mass and function by echocardiography were the main outcome measures.

Results: At study entry, the LV mass index was significantly lower in GHD children (50.2 ± 1.7) than in controls (60.3 ± 2.5 g/m²; P < 0.002), whereas LV systolic and diastolic function, lipid profile, insulin levels, and HOMA index were similar. In GHD children LV mass index significantly increased (66.3 ± 2.4 g/m²; P < 0.0001) after 1 yr of GH replacement and remained stable thereafter. LV systolic and diastolic function did not change during treatment. After 2 yr of GH replacement, total cholesterol (P < 0.007) and the atherogenic index (P < 0.0001) significantly decreased, whereas fasting insulin levels (P < 0.001) and HOMA index (P < 0.0001) significantly increased compared with both pretreatment and control values.

Conclusions: GHD in children is associated with a reduced cardiac size but with a normal cardiac function, lipid profile, and insulin sensitivity. Two years of GH replacement normalizes cardiac morphology, improves lipid profile, and slightly impairs insulin sensitivity.

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				D. Capalbo, A. Lo Vecchio, V. Farina, L. Spinelli, A. Palladino, C. Tiano, T. Lettiero, G. Lombardi, A. Colao, and M. Salerno Subtle Alterations of Cardiac Performance in Children with Growth Hormone Deficiency: Results of a Two-Year Prospective, Case-Control Study J. Clin. Endocrinol. Metab., September 1, 2009; 94(9): 3347 - 3355. [Abstract] [Full Text] [PDF]

				A Ciresi, M C Amato, A Criscimanna, A Mattina, C Vetro, A Galluzzo, G D'Acquisto, and C Giordano Metabolic parameters and adipokine profile during GH replacement therapy in children with GH deficiency Eur. J. Endocrinol., March 1, 2007; 156(3): 353 - 360. [Abstract] [Full Text] [PDF]

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