This Article Full Text (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 Google Scholar Google Scholar Articles by Jansson, J.-O. Articles by Svensson, J. Search for Related Content PubMed PubMed Citation Articles by Jansson, J.-O. Articles by Svensson, J.

Growth Hormone (GH) Replacement in Women in Relation to Their Endogenous GH Secretion

Research Center for Endocrinology and Metabolism, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden

Address correspondence to: Professor John-Olov Jansson, M.D., Ph.D., Research Center for Endocrinology and Metabolism, Gröna Stråket 8, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden. E-mail: JOJ{at}medic.gu.se.

To the editor:

In hypopituitary adult humans with GH deficiency, men have a more beneficial response to treatment with GH in terms of serum IGF-I concentration, body composition, and bone mineral density compared with women receiving a similar GH dose (1, 2). There are several possible explanations for this gender difference. Oral estrogen treatment has been shown to decrease the serum IGF-I response to GH in hypopituitary women (2) and, consequently, could be one explanation for the lesser treatment response in women. Moreover, total daily secretion of endogenous GH is higher in women than in men (3). However, it is not fully clear whether women can achieve a similar treatment response as men, even if they receive a higher dose of GH. Furthermore, there is a risk of increased fluid-related side effects in women if the dose of GH is increased.

The study by Jessup et al. (4) in the October 2003 issue of JCEM, which also is in line with previous studies (5), could add one further explanation to the gender difference in the response to treatment. Men produce most of their GH during nighttime, whereas women produce GH throughout the 24-h day (see Fig. 1 in Ref. 4). At present, the standard GH treatment is one daily sc GH injection given at bedtime. This regimen has been shown to increase mainly nighttime GH levels for about 12 h (6). Therefore, this serum GH pattern seems to be more similar to that observed in healthy men than to that in healthy women. We hypothesize that the present standard treatment with GH results in a serum pattern that is less beneficial in women, because it does not mimic their endogenous GH secretory pattern. Rodents have similar gender differences in the GH secretion pattern as humans, and it has been shown that gender-adapted GH treatment patterns result in appropriate physiological replacement effects (7). Further studies are needed to investigate whether the present GH replacement, including administration mode, is optimal in GH-deficient women.

Footnotes

A response to this letter was invited, but the authors of the original article (Jessup et al.) chose not to provide one.

Received December 24, 2003.

References

1. Götherström G, Svensson J, Koranyi J, Alpsten M, Bosæus I, Bengtsson B-Å, Johannsson G 2001 A prospective study of five years of growth hormone (GH) replacement therapy in GH-deficient adults; sustained effects on body composition, bone mass, and metabolic indices. J Clin Endocrinol Metab 86:4657–4665[Abstract/Free Full Text]
2. Drake W, Howell S, Monson J, Shalet S 2001 Optimizing GH therapy in adults and children. Endocr Rev 22:425–450[Abstract/Free Full Text]
3. Ho K, Evans W, Blizzard R, Veldhuis JD, Merriam GR, Samojlik E, Furlanetto R, Rogol AD, Kaiser DL, Thorner MO 1987 Effects of sex and age on the 24-hour profile of growth hormone secretion in man: importance of endogenous estradiol concentrations. J Clin Endocrinol Metab 64:51–58[Abstract]
4. Jessup S, Dimaraki E, Symons K, Barkan A 2003 Sexual dimorphism of growth hormone (GH) regulation in humans: endogenous GH-releasing hormone maintains basal GH in women but not in men. J Clin Endocrinol Metab 88:4776–4780[Abstract/Free Full Text]
5. Jaffe C, Ocampo-Lim B, Wensheng G, Krueger K, Sugahara I, DeMott-Friberg R, Bermann M, Barkan AL 1998 Regulatory mechanisms of growth hormone secretion are sexually dimorphic. J Clin Invest 102:153–164[Medline]
6. Oscarsson J, Johannsson G, Johansson J-O, Lundberg P-A, Lindstedt G, Bengtsson B-Å 1997 Diurnal variation in serum insulin-like growth factor (IGF)-I and IGF binding protein-3 concentrations during daily subcutaneous injections of recombinant human growth hormone in GH-deficient adults. Clin Endocrinol (Oxf) 46:63–68[CrossRef][Medline]
7. Jansson J-O, Edén S, Isaksson O 1985 Sexual dimorphism in the control of growth hormone secretion. Endocr Rev 6:128–150[Abstract]

This Article Full Text (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 Google Scholar Google Scholar Articles by Jansson, J.-O. Articles by Svensson, J. Search for Related Content PubMed PubMed Citation Articles by Jansson, J.-O. Articles by Svensson, J.