Does a gender-related effect of growth hormone (GH) replacement exist on cardiovascular risk factors, cardiac morphology, and performance and atherosclerosis? Results of a two-year open, prospective study in young adult men and women with severe GH deficiency.
BACKGROUND
GH secretion and response to GH replacement are gender-related.


OBJECTIVE
The objective of this study was to investigate the effects of GH deficiency (GHD) and replacement on the cardiovascular system according to gender.


METHODS
The design was open and prospective.


METHODS
The study was conducted at a university hospital.


METHODS
Subjects included 36 severe adult-onset GHD patients (18 men, 20 women, aged < 45 yr); 36 gender-, age-, and body mass index-matched healthy subjects served as controls.


METHODS
Subjects received GH replacement at a median dose of 6.5 microg/kg.d in men and 7.7 microg/kg.d in women for 2 yr.


METHODS
Homeostasis model assessment index, total to HDL cholesterol ratio, fibrinogen and C-reactive protein levels, left ventricular mass index, blood pressure, heart rate, diastolic filling, and systolic function at rest and at peak exercise and intima-media thickness (IMT) at common carotid arteries were measured.


RESULTS
Basal prevalence and/or degree of insulin resistance, lipid alterations, compromised cardiac function, and IMT were similar in women and men. Diastolic dysfunction was more prevalent in men (61 vs. 25%, P = 0.036). After GH replacement, IGF-I levels normalized in all patients. Lipid profile, fibrinogen, and C-reactive protein levels normalized in all cases. The total to HDL ratio (P = 0.04) was higher in women than men. The homeostasis model assessment index persisted higher in GHD patients than controls and decreased only in GHD men (P = 0.017). Left ventricular mass index normalized during treatment in both women and men, abnormal diastolic function persisted in three women (P = 0.031), and abnormal systolic performance persisted in six women and one man (P = 0.13). IMT decreased similarly in women and men, persisting higher than in controls. Exercise performance normalized in all.


CONCLUSIONS
Two-year GH replacement has similar beneficial effects on cardiac and exercise performance and atherosclerosis in women and men with severe GHD.
Department of Molecular and Clinical Endocrinology and Oncology, "Federico II" University of Naples, via S. Pansini 5, 80131 Naples, Italy. colao@unina.it
Annamaria
A
Colao
Carolina
C
Di Somma
Alberto
A
Cuocolo
Letizia
L
Spinelli
Wanda
W
Acampa
Stefano
S
Spiezia
Francesca
F
Rota
Maria Cristina
MC
Savanelli
Gaetano
G
Lombardi
D000328:Adult; D000886:Anthropometry; D002318:Cardiovascular Diseases / Q000209:etiology; D002319:Cardiovascular System / Q000187:drug effects*; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging; D016022:Case-Control Studies; D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D013006:Growth Hormone / Q000627:therapeutic use*; D020249:Hormone Replacement Therapy; D019382:Human Growth Hormone / Q000172:deficiency*; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D002537:Intracranial Arteriosclerosis / Q000000981:diagnostic imaging; D008297:Male; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000627:therapeutic use; D012307:Risk Factors; D012737:Sex Factors; D043202:Steroid Metabolism, Inborn Errors / Q000188:drug therapy*
D011994:Recombinant Proteins; D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I; D013006:Growth Hormone