Medium-term cardiovascular effects of high-dose growth hormone treatment in growth hormone-deficient children.
OBJECTIVE
To investigate the possible cardiac morphofunctional alterations inducd by prolonged and high-dose GH therapy in a group of 14 children with isolated GH deficiency.


METHODS
Patients were evaluated at phase 1, after 1.1 +/- 0.6 years of treatment with GH 0.93 +/- 0.13 U/kg/week, and at phase 2, after 5.5 +/- 2.1 years of therapy 0.89 +/- 0.11 U/kg/week. At each phase left ventricular volume, mass and systolic function were evaluated by two-dimensional guided M-mode echocardiography; left ventricular diastolic function was assessed by PW-Doppler sampling of transmitral flow.


RESULTS
Phase 1: diastolic blood pressure was lower (p < 0.05) and fractional shortening was not adequate for the level of afterload (stress shortening index p < 0.05) in patients compared to controls. Phase 2: diastolic blood pressure was lower (p < 0.01) and mass and mass/volume ratio were increased (mass index p < 0.05, mass/ volume ratio p < 0.05) in patients compared to controls. The increased mass/volume ratio, together with the normal systolic blood pressure, explains the reduction in peak systolic stress (p < 0.005). Among the parameters of left ventricular diastolic function, the peak E velocity/total area under mitral valve tracing and the area under E velocity/total area under mitral value tracing ratios were significantly decreased (p < 0.05).


CONCLUSIONS
After a mean period of 5 years on high-dose GH treatment in GH-deficient children, subclinical morphofunctional alterations in the left ventricle were found.
Radetti
G
G
Department of Pediatrics, Regional Hospital of Bolzano, Italy. G.Radetti@ntt.it
Crepaz
R
R
Paganini
C
C
Gentili
L
L
Pitscheider
W
W
D000293:Adolescent; D002319:Cardiovascular System / Q000187:drug effects* / Q000473:pathology / Q000503:physiopathology; D016022:Case-Control Studies; D002648:Child; D005260:Female; D006130:Growth Disorders / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D019382:Human Growth Hormone / Q000008:administration & dosage / Q000009:adverse effects* / Q000172:deficiency*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000139:chemically induced; D008297:Male; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000139:chemically induced
D019382:Human Growth Hormone