title: Effect of long-term growth hormone treatment on carbohydrate metabolism in children with growth hormone deficiency.
abstract: OBJECTIVE
  Growth hormone (GH) has well known effects on carbohydrate metabolism. We have evaluated the effects of long-term growth hormone (GH) therapy on carbohydrate metabolism in children with classical GH deficiency (GHD) or GH neurosecretory dysfunction (GHND).
  
  
  METHODS
  Glucose, insulin and C-peptide concentrations at baseline and during oral glucose tolerance test (OGTT) were measured before and after 18 and 36 months of GH therapy (0.6-0.8 IU/Kg/week in 6 evening doses) in 13 GHD and 7 GHND children (15 boys and 5 girls, 15 prepubertal and 5 early pubertal; age at diagnosis 2.11-13.1 y).
  
  
  RESULTS
  Mean fasting insulin and C-peptide concentrations after 18 months were similar to the pretreatment values, while after 36 months they were significantly higher than before treatment. Fasting glucose concentrations were similar to pretreatment both after 18 and 36 months. The mean areas under the curve (AUC) during OGTT for glucose, insulin, and C-peptide were significantly increased after 18 and 36 months. There were no differences between GHD and GHND patients. During the treatment period 10 of the 15 prepubertal patients entered puberty. A significant increase of insulin and C-peptide concentrations occurred after 36 months of GH treatment in the patients that remained prepubertal during treatment as well as in those who were pubertal when treatment was started. In three of our patients GH treatment caused glucose intolerance, which resolved after 6-12 months of a normal calorie low-simple carbohydrate diet without requiring discontinuation of treatment.
  
  
  CONCLUSIONS
  Our data show that long-term GH treatment in GH deficient children causes hyperglycaemia and increased insulin secretion. These effects may in some patients induce glucose intolerance, which is reversible with appropriate dietary measures and does not require discontinuation of treatment.
authors.affiliation: Dipartimento di Pediatria, Università di Firenze, Italy. seminara@cesitl.unifi.it
authors.forename: S
authors.initials: S
authors.lastname: Seminara
authors.forename: G
authors.initials: G
authors.lastname: Merello
authors.forename: S
authors.initials: S
authors.lastname: Masi
authors.forename: A
authors.initials: A
authors.lastname: Filpo
authors.forename: F
authors.initials: F
authors.lastname: La Cauza
authors.forename: G
authors.initials: G
authors.lastname: D'Onghia
authors.forename: E
authors.initials: E
authors.lastname: Martelli
authors.forename: S
authors.initials: S
authors.lastname: Loche
mesh_terms: D000293:Adolescent; D019540:Area Under Curve; D001786:Blood Glucose / Q000378:metabolism; D002096:C-Peptide / Q000097:blood; D050260:Carbohydrate Metabolism; D002648:Child; D002675:Child, Preschool; D005260:Female; D005951:Glucose Tolerance Test; D006130:Growth Disorders / Q000097:blood / Q000188:drug therapy* / Q000378:metabolism; D013006:Growth Hormone / Q000009:adverse effects / Q000172:deficiency* / Q000627:therapeutic use; D006801:Humans; D007328:Insulin / Q000097:blood; D008297:Male; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D001786:Blood Glucose; D002096:C-Peptide; D007328:Insulin; D013006:Growth Hormone