Endocrine Abstracts

Patients with GHD have an, adverse body composition, insulin resistance, atherogenic lipid profile and impaired quality of life. We undertook a single centre retrospective audit of hypopituitary adults to quantify the long-term effects of dose-titrated GH replacement.

The cohort comprised 53 patients defined as severely GHD using the GST (median peak GH 2.4 μ/l). Mean age 42±16.9 years, 23F, BMI 29.3±5.3 kg/m². GH was titrated until the IGF-I was within the upper tertile of the normative range and thereafter maintained.

Following 24 months of GH replacement there was a significant increase in BMI (28.0±5.7 vs 28.7±6.0 kg/m²; P=0.02), but no change in LBM (54.0±12.6 vs 55.8±11.5 kg; P=0.29) or FM (24.6±12.5 vs 23.8±13.3 kg; P=0.24). Percentage FM decreased significantly (31.0±9.9 vs 28.8±10.8%; P=0.002). There was a trend towards a decrease in truncal FM (14.2±8.1 vs 12.6±7.0 kg; P=0.14), supported by a decrease in truncal %FM (31.0±8.6 vs 28.2±9.1; P=0.005). Total body water increased significantly (39.7±8.4 vs 42.3±9.9 kg; P=0.014). No significant change in blood glucose (5.2±0.9 vs 5.2±0.8 mmol/l; P=0.85), HbA1c (5.36±0.36 vs 5.47±0.21%; P=0.77), WHR (0.939±0.104 vs 0.906±0.064; P=0.20), sBP (127±19 vs 123±7 mmHg; P=0.40) or dBP (79±11 vs 79±6.7 mmHg; P=0.56) was observed. There was a significant fall in TC (5.4±1.1 vs 4.9±0.7 mmol/l; P=0.04), LDL-C (3.4±1.0 vs 2.8±0.7 mmol/l; P=0.02), and TC:HDL (4.96±0.93 vs 5.02±1.12; P=0.02). Not unsurprisingly there was a significant improvement in the AGHDA (17.2±1.68 vs 6.6±6.8; P<0.0001) and overall PGWB score (52.2±21.2 vs 81.5±13.9; P<0.0001).

Twenty-four months of GH replacement titrated to normalise the IGF-I within the upper reaches of the normal range led to significant and sustained improvement of quality of life and psychological wellbeing. The impact on body composition of a 1.8 kg increase in LBM and 1.6 kg reduction in truncal fat mass is much less than observed in short-term studies previously published using weight-based GH regimens.