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Submitted on September 17, 2004
Accepted on January 28, 2005
Department of Molecular & Clinical Endocrinology and Oncology, "Federico II" University of Naples (A.C., C.D.S., F.R., G.L.), and Pediatrics (M.S.), Division of Pediatric Endocrinology, Santobono Hospital of Naples (S.D.M., A.K.) and Emergency Unit, "S. Maria degli Incurabili" Hospital of Naples (S.S.), Italy
* To whom correspondence should be addressed. E-mail: colao{at}unina.it.
We prospectively investigated the risk of early atherosclerosis, by classical cardiovascular risk factors and intima-media thickness (IMT) at common carotid arteries, in 23 adolescents diagnosed as GH deficient (GHD) during childhood and in 23 healthy sex-, age- and BMI-matched controls. Measurements were performed in all subjects before stopping GH replacement. Since the diagnosis of GHD had been confirmed in 15 of the 23 adolescents, the protocol changed according to the diagnosis as follows: measurements were repeated after 6 months of GH withdrawal and 6 months of GH re-institution in the 15 with GHD, and after 6 and 12 months of GH withdrawal, measurements were also taken in the 8 with non-GHD.
Serum IGF-I levels were in the normal range for age in all patients before GH withdrawal. When compared with controls, before GH withdrawal, GHD adolescents had reduced HDL-cholesterol levels and increased total/HDL-cholesterol ratio, fibrinogen, LDL-cholesterol, and glucose levels; non-GHD adolescents had increased glucose, insulin and HOMA. IMT at common carotid arteries was similar in GHD and controls (0.52 ± 0.03 vs. 0.55 ± 0.06 mm, P = 0.23) and was higher in non-GHD than in controls (0.62 ± 0.03 vs. 0.54 ± 0.06 mm, P = 0.01). In GHD adolescents, six months of GH treatment withdrawal and six months of GH treatment re-institution modified IGF-I levels, lipid profile, insulin resistance but not IMT, systolic and diastolic peak velocities common carotid arteries. In non-GHD, 12 months of GH treatment withdrawal significantly decreased IGF-I levels, IMT (to 0.54 ± 0.06 mm, P < 0.001 vs. baseline), systolic and diastolic peak velocities and improved insulin resistance.
In conclusion, the discontinuation of GH in confirmed GHD adolescents is not followed by significant alterations of common carotid arteries, in spite of the profound negative alterations of the lipid profile. In adolescents who were not confirmed to have GHD, IMT was increased while on GH therapy and normalized when they were taken off of GH.
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