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 .
Limited efficacy of growth hormone (GH) during transition of GH-deficient patients from adolescence to adulthood: a phase III multicenter, double-blind, randomized two-year trial.
CONTEXT Treatment of GH-deficient adolescents in transition to adulthood remains challenging . OBJECTIVE The objective was to assess the safety and efficacy of GH in GH-deficient adolescents in transition . PATIENTS Fifty-eight GH-deficient adolescents ( mean age , 15.8 + /- 1.8 yr ; 33 males ) at near completion of their linear growth participated in the study . INTERVENTION Baseline studies were done while subjects were on GH . Subjects were retested ( insulin-induced hypoglycemia ) 4 wk after GH discontinuation and reclassified as persistently GH-deficient or controls ( n = 18 ) . GH-deficient subjects were r and omized to GH ( n = 25 , approximately 20 microg/kg.d ) or placebo ( n = 15 ) . SETTING The multicenter study was conducted over a 2-yr period . MAIN OUTCOMES Changes in body composition , bone mineral density ( BMD ) , quality of life ( QOL ) , cardiovascular and metabolic markers were measured . RESULTS All groups had normal measures of lipid and carbohydrate metabolism , body composition , BMD , cardiac function , muscle strength , and QOL at baseline and after 2 yr . IGF-I concentrations decreased in all , but less so in the GH-group ( P = 0.013 ) . There was a greater increase in lean body mass ( lesser adiposity ) in the GH group than placebo at 12 months , but not at 24 months . CONCLUSIONS 1 ) GH-deficient patients properly treated in childhood can have normal BMD , body composition , cardiac function , muscle strength , carbohydrate and lipid metabolism , and QOL when reaching adult height ; and 2 ) continuation of GH therapy for 2 yr did not change these measures as compared to placebo-treated or control subjects . GH-deficient adolescents in good metabolic status at the time of epiphyseal fusion may safely discontinue GH for at least 2 yr . Follow-up is needed to determine whether GH therapy is eventually warranted in subjects treated with GH during childhood
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 .