Improvement in cardiac systolic function and reduced prevalence of metabolic syndrome after two years of growth hormone (GH) treatment in GH-deficient adult survivors of childhood-onset acute lymphoblastic leukemia.
BACKGROUND
Survivors of childhood-onset (CO) acute lymphoblastic leukemia (ALL) treated with prophylactic cranial radiotherapy often exhibit GH deficiency (GHD), which is associated with increased prevalence of cardiovascular risk factors and cardiac dysfunction.


OBJECTIVE
The objective of the study was to evaluate the effect of GH replacement on cardiovascular risk factors and cardiac function in former CO ALL patients.


METHODS
Eighteen former CO ALL patients (aged 19-32 yr) treated with cranial radiotherapy (18-24 Gy) and chemotherapy and with confirmed GHD were studied at baseline and after 12 (n = 18) and 24 months (n = 13) of GH treatment (median 0.5 mg/d). A group of 18 age- and sex-matched subjects served as controls.


RESULTS
After 12 months of GH treatment, a significant decrease in serum leptin (P = 0.002), leptin per kilogram fat mass (FM) (P = 0.01), plasma glucose (P = 0.004), FM (P = 0.002), and hip (P = 0.04) and waist (P = 0.02) circumference and increased muscle mass (P = 0.004) were recorded in the patients. Before GH treatment six patients had a metabolic syndrome, but after 12 months only one had it and after 24 months none. After 24 months of GH treatment, an increase in left ventricular mass index (P = 0.06) and significant improvements in cardiac systolic function, measured as fractional shortening (P = 0.03) and ejection fraction (P = 0.03), were recorded.


CONCLUSIONS
Improvement in cardiac systolic function and reduced prevalence of metabolic syndrome were recorded after 2 yr of GH replacement in former CO ALL patients with GHD. Long-term follow-up is highly warranted.
Follin
Cecilia
C
Department of Endocrinology, Lund University Hospital, SE-221 85 Lund, Sweden.
Thilén
Ulf
U
Ahrén
Bo
B
Erfurth
Eva Marie
EM
D015502:Absorptiometry, Photon; D000328:Adult; D001823:Body Composition / Q000502:physiology; D015992:Body Mass Index; D001835:Body Weight / Q000502:physiology; D002648:Child; D015150:Echocardiography, Doppler; D015444:Exercise / Q000502:physiology; D005260:Female; D013006:Growth Hormone / Q000627:therapeutic use*; D006321:Heart / Q000502:physiology*; D006334:Heart Function Tests; D006339:Heart Rate / Q000502:physiology; D019382:Human Growth Hormone / Q000172:deficiency* / Q000378:metabolism; D006801:Humans; D020738:Leptin / Q000097:blood; D008074:Lipoproteins / Q000097:blood; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology / Q000517:prevention & control*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000188:drug therapy / Q000532:radiotherapy; D012307:Risk Factors; D017741:Survivors; D049629:Waist-Hip Ratio
D020738:Leptin; D008074:Lipoproteins; D019382:Human Growth Hormone; D013006:Growth Hormone