Growth hormone deficiency in elderly patients with hypothalamo-pituitary tumors.
In 18 patients with hypothalamo-pituitary diseases aged over 60 years and in 18 sex, age- and BMI-matched healthy subjects, the results of plasma IGF-I and IGF-BP3 levels and the GH response to GHRH + arginine test (GHRH + ATT) were correlated to the results of body composition, serum osteocalcin (OC) and urinary cross-linked N-telopeptides of type I collagen (Ntx) and the bone mineral density (BMD). In 10 patients and 10 controls, the GH response to ITT was also evaluated. The GH response to GHRH + ATT and ITT was markedly reduced in patients compared to controls (3.1 +/- 0.7 vs. 23.2 +/- 2.3 micrograms/L, P < 0.001 and 1.1 +/- 0.3 vs. 6.4 +/- 0.8 micrograms/L, P < 0.001), so all patients were classified as GHD, though no significant difference was found in plasma IGF-I and IGF-BP3 levels between the two groups. Body composition analysis revealed a significant increase of fat mass (37.4 +/- 2.2 vs. 28.0 +/- 1.0%, P < 0.001), a significant decrease of lean mass (62.6 +/- 2.2 vs. 72.0 +/- 1.0%, P < 0.001) and total body water (45.7 +/- 1.5 vs. 52.5 +/- 1.1%, P < 0.001) in patients compared to controls. Serum OC levels were lower (1.9 +/- 0.1 vs. 4.6 +/- 0.4 micrograms/L, P < 0.001) in patients than in controls, whereas urinary Ntx levels were similar. BMD values in lumbar spine (0.81 +/- 0.02 vs. 0.90 +/- 0.02 g/cm2, P < 0.001) and femoral neck (0.70 +/- 0.02 vs. 0.82 +/- 0.02 g/cm2, P < 0.001) were significantly lower in patients than in controls. A significant inverse correlation was found between GHD duration and lumbar spine (r = -0.73, P&1t; 0.001) or femoral neck (r = -0.81, P&1t; 0.001) BMD values and a significant direct correlation was found between GH peak after GHRH + ATT and lumbar BMD (r = 0.69, p = 0.001) in GHD patients. In conclusion, GHD in patients over 60 yrs aged with a characteristic history of hypothalamus-pituitary pathology is distinct from the physiological decline in GH secretion associated with aging.
Colao
A
A
Department of Molecular and Clinical Endocrinology, Federico II University, Naples, Italy.
Cerbone
G
G
Pivonello
R
R
Klain
M
M
Aimaretti
G
G
Faggiano
A
A
Di Somma
C
C
Salvatore
M
M
Lombardi
G
G
D000368:Aged; D000375:Aging / Q000502:physiology*; D001120:Arginine; D001823:Body Composition; D015519:Bone Density; D016022:Case-Control Studies; D003094:Collagen / Q000652:urine; D024042:Collagen Type I; D005260:Female; D013007:Growth Hormone-Releasing Hormone; D019382:Human Growth Hormone / Q000172:deficiency* / Q000378:metabolism; D006801:Humans; D007029:Hypothalamic Neoplasms / Q000175:diagnosis / Q000503:physiopathology*; D007328:Insulin; D018972:Insulin-Like Growth Factor Binding Protein 3 / Q000097:blood; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D015675:Osteocalcin / Q000097:blood; D010455:Peptides / Q000652:urine; D010911:Pituitary Neoplasms / Q000175:diagnosis / Q000503:physiopathology*
D024042:Collagen Type I; D007328:Insulin; D018972:Insulin-Like Growth Factor Binding Protein 3; D010455:Peptides; C052929:collagen type I trimeric cross-linked peptide; D015675:Osteocalcin; D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I; D003094:Collagen; D013007:Growth Hormone-Releasing Hormone; D001120:Arginine