Endocrine Abstracts

Introduction: GH deficiency (GHD) leads to altered body composition, lipid metabolism and quality of life, and is also associated to an increased cardiovascular morbidity and mortality. The aim of this study was to evaluate long-term changes after treatment with GH replacement therapy (GHRT).

Methods: We retrospectively reviewed adult patients with GHD in our clinic who were treated with GHRT. We evaluated demographic (etiology, age, dose), anthropometric (body composition, bone mineral density), and analytical data (glucose, lipid, hepatic and renal profile, and IGF1 levels), as well as quality of life (QoLAGHDA), at the time of initiating GHRT and after the last dose.

Results: We evaluated 37 patients (31 males, aged 39.4±14 years at the onset of GHRT). There were nine cases of childhood-onset GHRT, seven due to congenital hypoplasia, and 28 cases with adult-onset, mainly due to surgical intervention after pituitary macroadenoma (14) and craneopharyngioma (4). Patients were treated during 9.2 (2–15) years. Mean duration of follow-up was 10.8 (1–23) years. GHRT dose increased from 0.20 (0.1–1.0) mg at onset, to 0.30 (0.1–1.2) mg at the last follow-up visit (P=0.05), and IGF1 levels increased (88±57.2 to 177.4±50.6 μg/l, P<0.001). We observed a decrease in body fat mass (36.6±9.3 to 33.1±8.1%, P=0.011) and an increase in BMI (26.9±5.0 to 28.4±5.6, P=0.014). No significant changes in body lean mass were found. An increase in Hba1c and HDL-C levels was noted (5.1±0.8 to 5.7±0.8%, P=0.007, and 51.45±15.0 to 59.88±21.7 mg/dl, P=0.003, respectively), but the decrease in LDL-C or triglyceride levels was not significant. No hepatic or renal side-effects were reported. A non-significant increase in vertebral and femoral neck T-score was noted. Quality of life improved (13.7–6.5 points, P<0.001). 4 patients developed diabetes (only 2 already presented it at the time of starting GHRT). GHRT was withdrawn due to lack of efficiency, increase in tumor volume or for re-evaluation in 3, 1 and 3 cases, respectively.

Conclusion: GHRT improved body fat mass, HDL-c and quality of life. The effect on glucose metabolism or bone mineral density may be controversial, and other changes were less relevant. The role of these modifications in the overall improvement of the cardiovascular risk in patients with GHD deserves further investigation.