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Baseline Characteristics and the Effects of Two Years of Growth Hormone (GH) Replacement Therapy in Adults with GH Deficiency Previously Treated for Acromegaly

Research Centre for Endocrinology and Metabolism (L.-L.N., G.J., J.S.), Sahlgrenska University Hospital, SE-41345 Göteborg, Sweden; and Research Group for Rehabilitation Medicine (K.S.S.), Institute of Neuroscience and Physiology, Göteborg University, SE-40530 Göteborg, Sweden

Address all correspondence and requests for reprints to: Johan Svensson, M.D., Research Centre for Endocrinology and Metabolism, Department of Internal Medicine, Gröna Stråket 8, Sahlgrenska University Hospital, SE-41345 Göteborg, Sweden. E-mail: johan.svensson{at}medic.gu.se.

Context: The effects of GH replacement in GH-deficient (GHD) adults previously treated for acromegaly are not well known.

Objective, Design, and Patients: In this single-center, open-labeled, prospective study, 10 consecutive GHD adults with cured acromegaly (A group) and 10 matched GHD adults with previous nonfunctioning hypopituitary disease (NF group) were included. Comparisons were made at baseline and in the responses in body composition, muscle strength, bone mass, and metabolic indices during 2 yr of GH replacement.

Results: At baseline, upper leg local muscle endurance and serum low-density lipoprotein-cholesterol concentration were more impaired in the A group. The A group contained three patients with hypertension, one with diabetes mellitus type 2, and one with hyperlipidemia. The NF group had only one patient with hypertension. There were no significant between-group differences in the responses to the GH therapy. Body composition and serum lipid pattern improved in both groups without any deterioration of glucose homeostasis. At study end, no difference remained between the two groups in any variable. During the 2-yr treatment, one patient had a myocardial infarction and two had cerebral infarctions in the A group, whereas no vascular event occurred in the NF group.

Conclusions: GHD patients with previous acromegaly have an impaired cardiovascular risk profile and decreased local muscle endurance as compared with other GHD patients. Two-year GH replacement eliminated these differences, but vascular events occurred more frequently in the A group. Therefore, GHD patients with cured acromegaly will benefit from GH replacement, but careful monitoring of cardiovascular status is needed.