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 .
Long-term monitoring of insulin sensitivity in growth hormone-deficient adults on substitutive recombinant human growth hormone therapy.
Since the effects of recombinant human growth hormone ( rhGH ) replacement therapy on glucose metabolism are still a matter of debate , the aim of the present study was to evaluate the impact of long-term rhGH treatment on insulin sensitivity . Simple indices of insulin resistance ( IR ) and insulin sensitivity ( IS ) , based on fasting glucose and insulin , such as the homeostasis model assessment of insulin resistance ( HOMA-IR ) and the quantitative insulin check index ( QUICKI ) , were used to estimate the degree of IR and IS in 20 normoglycemic patients ( 11 men and 9 women ; mean age , 44 + /- 14 years ) with severe adult-onset GH deficiency ( GHD ) . Measurements were determined at baseline and after 1 and 5 years of continuous rhGH therapy . Basal values were compared to those obtained in 20 healthy sex- and age-matched controls . Starting rhGH dose ranged from 3 to 8 microg/kg/d in keeping with sex and age , then doses were titrated according to insulin-like growth factor-I ( IGF-I ) levels . At baseline all patients had low IGF-I levels ( 10 + /- 5.4 nmol/L ) , high body mas index ( BMI ; 27.5 + /- 4 kg/m(2 ) ) , and elevated body fat percentage ( BF% ; 31.8 + /- 9.6 ) . Fasting glucose and insulin levels , as well as HOMA-IR and QUICKI , did not differ significantly from those recorded in the control group . After 1 year of rhGH replacement therapy , normalization in IGF-I levels and a significant reduction in BF% were observed ( P < .001 ) , and these effects were maintained after 5 years of treatment . Fasting glucose increased from 79 + /- 10 to 87 + /- 13 , and 87 + /- 12 mg/dL ( P < .05 ) after 1 and 5 years of therapy , respectively . Fasting insulin significantly increased after 1 year , without further modifications in the long-term follow-up . HOMA-IR significantly increased from 2.1 + /- 1.7 to 2.5 + /- 1.7 ( P < .05 ) after 1 year , then decreased to 2.3 + /- 1.5 ( P = not significant [ NS ] v basal ) after 5 years . A specular decrease in QUICKI from 0.37 + /- 0.05 to 0.34 + /- 0.03 ( P < .01 ) occurred after 1 year , with a trend to increase ( 0.35 + /- 0.04 ; P = NS v basal ) after 5 years . No patient developed impaired fasting glucose . In conclusion , rhGH therapy determined an increase in fasting glucose and insulin levels , causing in the short-term period a worsening of IS . The sustained reduction in BF% , without further deterioration of IS , suggests that long-term beneficial effects on body composition may overcome the negative influence of GH on glucose metabolism
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 .