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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.

This article has been cited by other articles:

				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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