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Submitted on November 28, 2005
Accepted on March 6, 2006
Department of Molecular and Clinical Endocrinology and Oncology, Section of Endocrinology, "Federico II" University of Naples, Italy; Emergency Unit, "S. Maria degli Incurabili" Hospital of Naples, Italy
* To whom correspondence should be addressed. E-mail: colao{at}unina.it.
Background Partial GH deficiency (GHD) in adults is poorly studied.
Objective To investigate the natural history and clinical implications of partial GHD.
Study design Analytical, observational, prospective, case-control.
Patients 27 hypopituitary patients (15 women, age 20-60 yr) and 27 controls.
Main outcome measures GH peak after GHRH plus Arginine [(GHRH+ARG), measured by IRMA], IGF-I (measured after ethanol extraction) z-SD score (SDS), glucose, insulin, total-cholesterol, HDL-cholesterol, and triglycerides levels, 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 HOMA 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 BMI 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/HDL cholesterol ratio, triglycerides, HOMA index and carotid IMT; normalization of GH secretion was accompanied by increased IGF-I SDS. By ROC 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 
11.5 µg/liter and IGF-I SDS -0.28 were highly predictive of delayed deterioration of GH secretion.
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