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 .
Effects of 7 years of growth hormone replacement therapy in hypopituitary adults.
Short-term studies of GH replacement in adult hypopituitarism have usually demonstrated beneficial effects on body composition and circulating lipids , with neutral or occasionally adverse effects on glucose tolerance . Fasting hyperinsulinemia has been reported . GH effects on cardiac function have been variable . The effects of long-term GH therapy , taking into account the consequences of increasing age , are not fully known . Thirty-three hypopituitary , initially middle-aged adults were studied over a 7-yr period ; 12 patients took GH therapy ( mean , 0.7 mg daily ) continuously ( group A ) ; 11 took GH for only 6 - 18 months , a minimum of 5 yr previously ( group B ) ; and 10 patients never received GH therapy  ( group C ) . Other pituitary replacement was maintained . Effects on anthropometry , body composition ( by bioimpedance analysis , total body potassium , and dual energy x-ray absorptiometry ) , circulating lipids , glucose and insulin concentrations , cardiac 2-dimensional and Doppler echocardiography , and exercise tolerance were assessed before and after the treatment period . Continuous GH therapy had no significant effect on body weight , but it prevented the increase in waist circumference and waist to hip ratio that occurred in the patients without GH substitution ( waist to hip ratio , group A , 0.87+/-0.08 at baseline , 0.85+/-0.09 at 7 yr ; group B , 0.89+/-0.11 at baseline , 0.94+/-0.11 at 7 yr ; P < 0.005 for GH effect ; group C , 0.87+/-0.10 at baseline , 0.92+/-0.10 at 7 yr ; P < 0.005 for GH effect ) . A GH-induced decrease in subscapular skinfold thickness was also observed . By bioimpedance analysis , GH therapy caused an increase in total body water and fat-free mass , and a decrease in the percent body fat . Although changes occurred with time in all groups , no significant additional GH therapy effects were observed on glucose tolerance , insulin concentrations , lipid levels , cardiac dimensions , echocardiographic diastolic function , or exercise tolerance . In conclusion , prolonged GH substitution in middle-aged hypopituitary adults causes a sustained improvement in body composition . Other benefits , e.g. on lipid levels and exercise tolerance , were not apparent at 7 yr when comparisons were made with GH-untreated hypopituitary controls . Potentially adverse effects on glucose tolerance and insulinemia did not develop with prolonged GH therapy
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 .