A 10-year, prospective study of the metabolic effects of growth hormone replacement in adults.

@article{citeulike:2216465, abstract = {CONTEXT: Only a few studies have investigated the effects of GH replacement in adults for more than 5 yr. OBJECTIVE/DESIGN/PATIENTS: In a prospective, open-label, single-center study, the effects of 10-yr GH replacement were determined. Eighty-seven consecutive patients (52 men and 35 women), with a mean age of 44.1 (range 22-74) yr with adult-onset GH deficiency (GHD) were included. RESULTS: The initial mean dose of GH (0.98 mg/d) was reduced during the study and at yr 10 was 0.47 mg/d. The mean IGF-I sd score increased from -1.81 at baseline to 1.29 at study end. The absolute reduction in total body fat was transient. However, after correction for age and sex using a four-compartment model, the reduction in body fat was sustained during the 10-yr study period. There was a sustained improvement in serum lipid profile and after 10 yr, and blood glycosylated hemoglobin level was reduced. The treatment responses in IGF-I sd score, serum high-density lipoprotein cholesterol level, and body composition as measured using dual-energy x-ray absorptiometry were more marked in men, whereas women had a more marked reduction in blood glycosylated hemoglobin level. CONCLUSION: The effect on the absolute amount of body fat was seen early and was transient, which could be due to the normal aging of the patients. The effects on metabolic indices were detected later, but they were sustained and even progressive throughout the study period.}, address = {Research Centre for Endocrinology and Metabolism, Department of Clinical Nutrition, Gr\"{o}na Str\r{a}ket 8, Sahlgrenska University Hospital, SE-413 45 G\"{o}teborg, Sweden. galina.gotherstrom@medic.gu.se}, author = {G\"{o}therstr\"{o}m, G. and Bengtsson, B. A. and Bosaeus, I. and Johannsson, G. and Svensson, J. }, citeulike-article-id = {2216465}, comment = {87 growth hormone deficient subjects were treated in a prospective non-blinded uncontrolled fashion with GH replacement therapy for 10 years. During this period of time, the average GH dose decreased from 0.98 to 0.47 mg/d, as the investigators stopped using a weight-based paradigm and began titrating the dose to the serum IGF-I level. As a result, the treatment-induced IGF-I SDS scores (-1.81 at baseline) declined from an “acromegalic” level of +3.10 after 1 year of therapy to a physiologic +1.29 at year 10. Using a 5-compartment model, fat mass fell from 23.7 to 19.8 kg after one year of treatment, but after 10 years of therapy, fat mass had nearly returned to baseline at 22.6; however, it is likely that fat mass would have increased significantly over that time period if GH had not been used when one considers the fact that adiposity increases with age and that there has been a secular trend of increased adiposity world-wide. Improvements in metabolic indices persisted over the ten years of treatment. Total cholesterol and LDL cholesterol showed consistent declines that have not yet plateaued after 10 years of therapy; similarly, HDL cholesterol continues to increase. HgA1c levels increased after 1-3 years of therapy, perhaps because supraphysiologic doses of GH were still being used; HgA1c fell from 4.90\% at baseline to 4.59\% by year 10, after 5 years of normal IGF-I levels. This important large observational trial shows that physiologic growth hormone therapy leads to persistent improvements in metabolic indices in GHD adults, and emphasizes the importance of titrating the GH dose to maintain IGF-I levels in the normal age-adjusted range. Andrew R. Hoffman }, doi = {10.1210/jc.2006-1487}, issn = {0021-972X}, journal = {J Clin Endocrinol Metab}, keywords = {r-gh}, month = {April}, number = {4}, pages = {1442--1445}, posted-at = {2008-01-10 22:24:41}, priority = {2}, title = {A 10-year, prospective study of the metabolic effects of growth hormone replacement in adults.}, url = {http://dx.doi.org/10.1210/jc.2006-1487}, volume = {92}, year = {2007} }

TY - JOUR ID - citeulike:2216465 L3 - citeulike-article-id:2216465 TI - A 10-year, prospective study of the metabolic effects of growth hormone replacement in adults. JF - J Clin Endocrinol Metab VL - 92 IS - 4 SP - 1442 EP - 1445 AD - Research Centre for Endocrinology and Metabolism, Department of Clinical Nutrition, Gröna Stråket 8, Sahlgrenska University Hospital, SE-413 45 Göteborg, Sweden. galina.gotherstrom@medic.gu.se SN - 0021-972X N2 - CONTEXT: Only a few studies have investigated the effects of GH replacement in adults for more than 5 yr. OBJECTIVE/DESIGN/PATIENTS: In a prospective, open-label, single-center study, the effects of 10-yr GH replacement were determined. Eighty-seven consecutive patients (52 men and 35 women), with a mean age of 44.1 (range 22-74) yr with adult-onset GH deficiency (GHD) were included. RESULTS: The initial mean dose of GH (0.98 mg/d) was reduced during the study and at yr 10 was 0.47 mg/d. The mean IGF-I sd score increased from -1.81 at baseline to 1.29 at study end. The absolute reduction in total body fat was transient. However, after correction for age and sex using a four-compartment model, the reduction in body fat was sustained during the 10-yr study period. There was a sustained improvement in serum lipid profile and after 10 yr, and blood glycosylated hemoglobin level was reduced. The treatment responses in IGF-I sd score, serum high-density lipoprotein cholesterol level, and body composition as measured using dual-energy x-ray absorptiometry were more marked in men, whereas women had a more marked reduction in blood glycosylated hemoglobin level. CONCLUSION: The effect on the absolute amount of body fat was seen early and was transient, which could be due to the normal aging of the patients. The effects on metabolic indices were detected later, but they were sustained and even progressive throughout the study period. KW - r-gh N1 - 87 growth hormone deficient subjects were treated in a prospective non-blinded uncontrolled fashion with GH replacement therapy for 10 years. During this period of time, the average GH dose decreased from 0.98 to 0.47 mg/d, as the investigators stopped using a weight-based paradigm and began titrating the dose to the serum IGF-I level. As a result, the treatment-induced IGF-I SDS scores (-1.81 at baseline) declined from an “acromegalic” level of +3.10 after 1 year of therapy to a physiologic +1.29 at year 10. Using a 5-compartment model, fat mass fell from 23.7 to 19.8 kg after one year of treatment, but after 10 years of therapy, fat mass had nearly returned to baseline at 22.6; however, it is likely that fat mass would have increased significantly over that time period if GH had not been used when one considers the fact that adiposity increases with age and that there has been a secular trend of increased adiposity world-wide. Improvements in metabolic indices persisted over the ten years of treatment. Total cholesterol and LDL cholesterol showed consistent declines that have not yet plateaued after 10 years of therapy; similarly, HDL cholesterol continues to increase. HgA1c levels increased after 1-3 years of therapy, perhaps because supraphysiologic doses of GH were still being used; HgA1c fell from 4.90% at baseline to 4.59% by year 10, after 5 years of normal IGF-I levels. This important large observational trial shows that physiologic growth hormone therapy leads to persistent improvements in metabolic indices in GHD adults, and emphasizes the importance of titrating the GH dose to maintain IGF-I levels in the normal age-adjusted range. Andrew R. Hoffman AU - Götherström, G AU - Bengtsson, BA AU - Bosaeus, I AU - Johannsson, G AU - Svensson, J PY - 2007/04// UR - http://dx.doi.org/10.1210/jc.2006-1487 ER -