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 .
Continued growth hormone (GH) treatment after final height is necessary to complete somatic development in childhood-onset GH-deficient patients.
Lean body mass ( LBM ) , fat mass ( FM ) , and total bone mineral content are significantly reduced in adult GHD subjects who had received pediatric GH .  To test the hypothesis that continued GH therapy after final height is necessary to attain adult body composition , we performed a prospect i ve , multinational , r and omized , controlled , 2-yr study in patients who completed pediatric GH treatment at final height . Patients were r and omized to GH at 25.0 microg/kg x d ( pediatric dose ; n = 58 ) or 12.5 microg/kg x d ( adult dose ; n = 59 ) or no GH treatment ( control ; n = 32 ) . LBM and FM were measured by dual energy x-ray absorptiometry and were central ly evaluated . IGF-I , IGF-binding protein-3 , and lipid concentrations were also measured central ly . During the 2 yr , GH-treated patients gained a significant amount of LBM compared with controls ( P < 0.001 ) , but the change with the higher pediatric dose ( 14.2 + /- 11.7 % ) was not different from that seen with the lower adult dose ( 12.7 + /- 9.4 % ; P = 0.970 ) . Similarly , the decrease in FM was significantly ( P = 0.029 ) influenced by treatment , but with no dose effect ( adult dose , -7.1 + /- 22.8 % ; pediatric dose , -6.0 + /- 26.6 % ; P = 0.950 ) . When the GH treatment effect was analyzed by gender , males gained 15.6 + /- 9.8 % and 14.3 + /- 11.7 % LBM ( P = 0.711 ) and lost 12.4 + /- 22.2 % and 11.0 + /- 27.1 % FM ( P = 0.921 ) with the low and high doses , respectively . Females gained 8.3 + /- 7.3 % and 12.5 + /- 12.8 % LBM with the two doses ( P = 0.630 ) , but increased their FM by 3.5 + /- 16.2 % with the lower dose and lost only 1.2 + /- 23.2 % FM with the higher dose ( P = 0.325 ) . A similar pattern was seen in IGF-I sd score ; the 2-yr GH dose response was significantly higher with the pediatric than with the adult dose in females ( P = 0.008 ) , but not males ( P = 0.790 ) . The divergent pattern of change in LBM and FM in males and females is consistent with normal developmental sexual dimorphism and indicates that GH-dependent progress to target body composition continues after the age at which GH treatment is usually terminated . Dose requirements may have to be adjusted by gender , with females requiring a higher dose than males
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 .