Endocrine Abstracts

Objectives: GHR in adults with GHD favourably effects body composition (reduces fat and increases lean body mass) although body weight usually remains unchanged. However the effect of GHR on ingestive behaviour and voluntary physical activity in adults has not been studied.

Methods: We studied 10 hypopituitary adults (8 males, 2 females, mean age 49.7 years) with severe GHD (mean peak GH response to glucagon 3.26 mU/l, baseline IGF-1 level 14.5 nmol/L) before and after GHR (mean duration 9.4 months; mean GH dose 0.35 mg daily). The following were measured pre and post GHR:

Resting energy expenditure (REE) by indirect calorimetry;voluntary activity for a week (pedometer); hunger and satiety scores (visual analog scales [VAS] fasting and after a fixed calorie breakfast {600 kcal}); energy intake during a buffet lunch; anthropometric measures (weight, BMI, waist hip ratio, body fat percentage by bio-impedance) and quality of life (QoL-AGHDA scores). Local research Ethics Committee approval was obtained.

Results: After nine months of GHR, significant improvements in QoL-AGHDA scores (16 vs 7, P 0.016) and activity scores (2330 vs 4220, P 0.029) were found, however BMI was unchanged (31.9 pre v 31.5 post GH, P 0.49). After GH, fasting hunger VAS scores were higher (73.1 vs 54.5, P 0.01) and patients ingested more carbohydrates (436.4 Kcal vs 370.8 Kcal, P 0.048). Satiety VAS scores, anthropometric measures and REE were unchanged.

Conclusions: GHR improves QoL and activity levels but also increases fasting hunger scores and carbohydrate intake. Adults commencing GH replacement should be counselled about restricting energy intake to mitigate weight gain and achieve weight loss.