Coronary flow reserve is impaired in patients with adult growth hormone (GH) deficiency.
OBJECTIVE
Relationship between adult growth hormone deficiency (AGHD) and increased cardiovascular disease risk is very well known in hypopituitary patients treated with conventional hormone replacement therapy other than growth hormone (GH) administration. Endothelial dysfunction, an early and reversible event in pathogenesis of atherosclerosis, is associated with increased vascular smooth muscle tone, arterial stiffening and intima-media thickness (IMT). Coronary flow reserve (CFR) measurement by transthoracic Doppler echocardiography (TTDE) reflects coronary microvascular and endothelial functions, as a cheaper and an easy screening test. We have used TTDE to evaluate endothelial function and coronary microvascular function in AGHD.


METHODS
Cross-sectional observational study.


METHODS
A total of 10 GH-deficient adults on conventional replacement therapy other than GH (4 males, 6 females; mean age 37 +/- 11 years) and 15 healthy subjects (7 males, 8 females; mean age 41 +/- 11 years) were studied. Patients and controls were all nonsmokers, normotensive and nondiabetic.


METHODS
IGF-1, free T4, lipid profile, insulin, glucose, insulin resistance (IR), anthropometrical and physical parameters were recorded. CFR recordings and IMT measurements were performed using the Vivid 7 echocardiography device.


RESULTS
IMT were significantly higher in patients than controls (0.70 + 0.19 mm and 0.53 + 0.13 mm, respectively; P = 0.02). CFR was significantly lower in patients than in controls (1.96 +/- 0.35 and 2.62 +/- 0.45, respectively; P < 0.001). CFR was positively correlated with IGF-1 levels (r = 0.54, P = 0.005).


CONCLUSIONS
CFR is significantly lower in adults with GH deficiency than in controls. Direct correlation between CFR and IGF-1 concentrations suggests GH replacement could improve microvascular function and thereby could decrease cardiovascular morbidity and mortality in AGHD.
Oflaz
Huseyin
H
Deaprtment of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
Sen
Fatma
F
Elitok
Ali
A
Cimen
Arif Oguzhan
AO
Onur
Imran
I
Kasikcioglu
Erdem
E
Korkmaz
Semra
S
Demirturk
Mustafa
M
Kutluturk
Faruk
F
Pamukcu
Burak
B
Ozbey
Nese
N
D000328:Adult; D001783:Blood Flow Velocity; D016022:Case-Control Studies; D003326:Coronary Circulation; D003331:Coronary Vessels; D003430:Cross-Sectional Studies; D015150:Echocardiography, Doppler; D004730:Endothelium, Vascular / Q000000981:diagnostic imaging / Q000378:metabolism*; D005260:Female; D013006:Growth Hormone / Q000172:deficiency*; D006801:Humans; D007018:Hypopituitarism / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000378:metabolism*; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D012815:Signal Processing, Computer-Assisted; D017540:Tunica Media / Q000000981:diagnostic imaging / Q000378:metabolism
D007334:Insulin-Like Growth Factor I; D013006:Growth Hormone