This Article Full Text Full Text (PDF) All Versions of this Article: 91/6/2191    most recent Author Manuscript (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 Colao, A. Articles by Lombardi, G. Search for Related Content PubMed PubMed Citation Articles by Colao, A. Articles by Lombardi, G. Related Collections Neuroendocrinology and Pituitary Cardiovascular Endocrinology

The Natural History of Partial Growth Hormone Deficiency in Adults: A Prospective Study on the Cardiovascular Risk and Atherosclerosis

Department of Molecular and Clinical Endocrinology and Oncology (A.C., C.D.S., F.R., R.P., S.Sa., G.L.), Section of Endocrinology, "Federico II" University of Naples, and Emergency Unit (S.Sp.), "S. Maria degli Incurabili" Hospital of Naples, 80131 Naples, Italy

Address all correspondence and requests for reprints to: Annamaria Colao, M.D., Department of Molecular and Clinical Endocrinology and Oncology, "Federico II" University, via S. Pansini 5, 80131 Napoli, Italy. E-mail: colao{at}unina.it.

Background: Partial GH deficiency (GHD) in adults is poorly studied.

Objective: The objective of the study was to investigate the natural history and clinical implications of partial GHD.

Study Design: This was an analytical, observational, prospective, case-control study.

Patients: Twenty-seven hypopituitary patients (15 women, ages 20–60 yr) and 27 controls participated in the study.

Main Outcome Measures: Measures included GH peak after GHRH plus arginine [(GHRH+ARG), measured by immunoradiometric assay]; IGF-I (measured after ethanol extraction) z-SD score (SDS); glucose, insulin, total cholesterol, high-density lipoprotein (HDL) cholesterol, and triglyceride levels; and common carotid arteries intima-media thickness (IMT) measured periodically.

Results: At study entry, partial GHD patients had significantly lower IGF-I and HDL-cholesterol levels and homeostasis model assessment index than controls. During the 60 months of median follow-up, 11 patients had severe GHD (40.7%), seven normalized their GH response (25.9%), and nine showed persistently partial GHD (33.3%). Patients with developed severe GHD at baseline had similar age and body mass index and lower GH peak (11.5 ± 1.8 vs. 14.3 ± 1.5 and 12.8 ± 1.1 µg/liter, P = 0.008) and IGF-I SDS (–0.88 ± 0.48 vs. 0.15 ± 0.58 and –0.42 ± 0.78; P = 0.01) than the patients with normal GH secretion or partial GHD. Severe GHD was accompanied by decreased IGF-I SDS and increased total to HDL cholesterol ratio, triglycerides, homeostasis model assessment index, and carotid intima-media thickness; normalization of GH secretion was accompanied by increased IGF-I SDS. By receiving-operator characteristic analysis, predictors of severe GHD were a baseline GH peak after GHRH+ARG of 11.5 µg/liter (sensitivity 64%, specificity 94%) and a baseline IGF-I SDS of –0.28 (sensitivity 91%, specificity 63%).

Conclusions: Of 27 patients with partial GHD after pituitary surgery, 40.7% developed severe GHD and 25.9% normalized their GH response. With the assay used, changes in the GH peak response to GHRH+ARG were accompanied by changes in the IGF-I SDS, metabolic profile, and carotid IMT. A peak GH of 11.5 µg/liter or less and IGF-I SDS –0.28 or less were highly predictive of delayed deterioration of GH secretion.

This article has been cited by other articles:

				A. Colao, C. Di Somma, T. Cascella, R. Pivonello, G. Vitale, L. F S Grasso, G. Lombardi, and S. Savastano Relationships between serum IGF1 levels, blood pressure, and glucose tolerance: an observational, exploratory study in 404 subjects Eur. J. Endocrinol., October 1, 2008; 159(4): 389 - 397. [Abstract] [Full Text] [PDF]

				G. Gelwane, C. Garel, D. Chevenne, P. Armoogum, D. Simon, P. Czernichow, and J. Leger Subnormal Serum Insulin-Like Growth Factor-I Levels in Young Adults with Childhood-Onset Nonacquired Growth Hormone (GH) Deficiency Who Recover Normal GH Secretion May Indicate Less Severe but Persistent Pituitary Failure J. Clin. Endocrinol. Metab., October 1, 2007; 92(10): 3788 - 3795. [Abstract] [Full Text] [PDF]

				N. di Iorgi, A. Secco, F. Napoli, C. Tinelli, A. Calcagno, N. Fratangeli, L. Ambrosini, A. Rossi, R. Lorini, and M. Maghnie Deterioration of Growth Hormone (GH) Response and Anterior Pituitary Function in Young Adults with Childhood-Onset GH Deficiency and Ectopic Posterior Pituitary: A Two-Year Prospective Follow-Up Study J. Clin. Endocrinol. Metab., October 1, 2007; 92(10): 3875 - 3884. [Abstract] [Full Text] [PDF]

				G. Brabant, A. Krogh Rasmussen, B. M. K. Biller, M. Buchfelder, U. Feldt-Rasmussen, K. Forssmann, B. Jonsson, M. Koltowska-Haggstrom, D. Maiter, B. Saller, et al. Clinical Implications of Residual Growth Hormone (GH) Response to Provocative Testing in Adults with Severe GH Deficiency J. Clin. Endocrinol. Metab., July 1, 2007; 92(7): 2604 - 2609. [Abstract] [Full Text] [PDF]

				R. D. Murray, M. Bidlingmaier, C. J. Strasburger, and S. M. Shalet The Diagnosis of Partial Growth Hormone Deficiency in Adults with a Putative Insult to the Hypothalamo-Pituitary Axis J. Clin. Endocrinol. Metab., May 1, 2007; 92(5): 1705 - 1709. [Abstract] [Full Text] [PDF]

				F. Pecori Giraldi, M. Andrioli, L. De Marinis, A. Bianchi, A. Giampietro, M. De Martin, E. Sacco, M. Scacchi, A. Pontecorvi, and F. Cavagnini Significant GH deficiency after long-term cure by surgery in adult patients with Cushing's disease Eur. J. Endocrinol., February 1, 2007; 156(2): 233 - 239. [Abstract] [Full Text] [PDF]