Emerging cardiovascular risk factors/markers such as proinflammatory cytokines , C-reactive protein , and adipokines are also increased in GHD patients .
Increased cardiovascular morbidity and mortality have also been reported in GHD .
GH treatment has been shown to improve both traditional and emerging cardiovascular risk factors and markers .
The GHD population may be considered at high cardiovascular risk , and GH substitution may be expected to bring an added value to patients with hypopituitarism in terms of cardiovascular protection .
CONTEXT GH deficiency ( GHD ) of the adult is a clinical condition characterized by the presence of several traditional and emerging cardiovascular risk factors that can significantly increase cardiovascular morbidity and mortality .
It is still an open issue whether GH replacement is able not only to improve cardiovascular risk factors but also to decrease cardiovascular morbidity and mortality .
EVIDENCE SYNTHESIS In untreated GHD , cardiovascular risk is increased due to abnormal lipid profile ( increased total and low-density lipoprotein cholesterol , increased triglycerides , and reduced high-density lipoprotein cholesterol ) and impaired glucose metabolism .
The influence of growth hormone replacement on peripheral inflammatory and cardiovascular risk markers in adults with severe growth hormone deficiency.
BACKGROUND Adult GHD syndrome is associated with clustering of adverse cardiovascular ( CV ) risk factors such as abnormal body composition , dyslipidemia , insulin resistance and abnormal haemostatic factors . There is a wealth of evidence linking CV events with elevated levels of inflammatory markers ( hs-CRP and IL-6 ) in the general population ; however data on their abnormalities in GHD and specially the effects of GH replacement ( GHR ) on these inflammatory markers are limited . OBJECTIVE To study the effects of GHR on inflammatory markers , glucose homeostasis and body composition in a cohort of adults with recently diagnosed severe GHD due to hypothalamic pituitary disease . DESIGN Fifteen hypopituitary adults ( 11 males , mean age 48.5 years ) with recently diagnosed , severe GHD were recruited . Patients received GHR ( in addition to other pituitary hormone replacements ) titrated to clinical response and to normalize age and gender adjusted IGF-1 levels . Weight , waist hip ratio ( WHR ) , body composition , fasting plasma glucose and insulin , insulin resistance index ( HOMA-IR ) , fasting serum lipid levels , hs-CRP , IL-6 and TNF-alpha were measured at baseline and following a minimum 6 months of stable maintenance GHR . RESULTS GHR result ed in a physiological increase in IGF-1 SDS [ median -0.6 to + 0.39 , P<0.0001 ] , improved quality of life ( mean pre-treatment AGHDA score 16 vs. post-treatment score 7 , P<0.0001 ) and reduction in WHR ( 0.94 vs. 0.92 , P=0.01 ) . There were no significant changes in body weight and composition . Levels of hs-CRP ( log transformed , mean ( SD ) ) were significantly reduced following GHR ( pre 1.21 ( 0.9 ) vs. post 0.27 ( 0.9 ) , P<0.0001 ) but TNF-alpha and IL-6 levels remained unchanged . Fasting glucose ( mmol/L ) [ 4.6 ( 0.1 ) vs. 5.1 ( 0.1 ) , P=0.003 ] , fasting insulin ( muU/mL ) [ 9.4 ( 8.1 ) vs. 12.1 ( 9.2 ) , P=0.03 ] and HOMA-IR [ 1.2 ( 1.0 ) vs. 1.5 ( 1.1 ) P=0.02 ] ( all pre-GHR vs. post-GHR and mean ( SD ) ) significantly increased following GHR indicating increased insulin resistance . Significant improvements were noted in fasting LDL-cholesterol ( LDL-C ) and HDL-cholesterol ( HDL-C ) levels following GHR [ 3.4 ( 0.9 ) vs. 2.9 ( 0.7 ) , P=0.03 and 1.2 ( 0.2 ) vs. 1.3 ( 0.2 ) , P=0.02 , respectively ] ( all pre-GHR vs. post-GHR and mean ( SD ) ) . Levels of total cholesterol and triglycerides did not change following GHR . CONCLUSIONS Physiological GHR for at least 6 months in hypopituitary adults with recently diagnosed severe GHD result ed in favourable changes in hs-CRP , WHR , fasting LDL-C and HDL-C levels all of which are recognised CV risk markers . However , there remains a high prevalence of obesity in this population and given the worsening of insulin sensitivity in the short term with GHR , monitoring and aggressive treatment of established CV risk factors is essential to reduce premature atherosclerotic CVD in this patient population
Emerging cardiovascular risk factors/markers such as proinflammatory cytokines , C-reactive protein , and adipokines are also increased in GHD patients .
Increased cardiovascular morbidity and mortality have also been reported in GHD .
GH treatment has been shown to improve both traditional and emerging cardiovascular risk factors and markers .
The GHD population may be considered at high cardiovascular risk , and GH substitution may be expected to bring an added value to patients with hypopituitarism in terms of cardiovascular protection .
CONTEXT GH deficiency ( GHD ) of the adult is a clinical condition characterized by the presence of several traditional and emerging cardiovascular risk factors that can significantly increase cardiovascular morbidity and mortality .
It is still an open issue whether GH replacement is able not only to improve cardiovascular risk factors but also to decrease cardiovascular morbidity and mortality .
EVIDENCE SYNTHESIS In untreated GHD , cardiovascular risk is increased due to abnormal lipid profile ( increased total and low-density lipoprotein cholesterol , increased triglycerides , and reduced high-density lipoprotein cholesterol ) and impaired glucose metabolism .