N-terminal pro-B-type natriuretic peptide in patients with growth hormone disturbances.
BACKGROUND
Acromegaly is associated with hypertrophic cardiomyopathy, hypertension and subsequent congestive heart failure. Impairment of cardiac function has also been associated with growth hormone deficiency (GHD). B-type natriuretic peptides (BNPs) have emerged as strong diagnostic and prognostic risk markers. They are cardioprotective hormones that compensate heart disease by promoting natriuresis and modulation of cardiac hypertrophy in response to volume expansion and ventricular wall stretch.


OBJECTIVE
To investigate N-terminal pro-BNP (NT-proBNP) in patients with GH disturbances before and after treatment, and in healthy gender- and age-matched controls.


METHODS
Ten acromegalic patients (age 48 +/- 12 years) and 10 patients with GHD (age 41 +/- 14 years) were studied. None had symptoms or signs of cardiovascular disease except for hypertension. Serum NT-proBNP was measured before and 3, 6, 12 and 24 months after treatment.


RESULTS
Baseline NT-proBNP was lower in acromegalic patients [median (interquartile range) 24.3 (17.8-33.0) pg/ml] than in 20 healthy matched controls [57.9 (35.4-92.2) pg/ml; P < 0.001]. NT-proBNP increased during treatment (P = 0.002), concomitant with a decrease in IGF-I (P < 0.001). After 3 months of treatment NT-proBNP peaked, with a fourfold increase to 96.4 (57.8-113.2) pg/ml. NT-proBNP did not differ in patients with GHD compared with controls (P = 0.19), and did not change during treatment (P = 0.39).


CONCLUSIONS
Untreated patients with acromegaly had low NT-proBNP levels that increased fourfold after treatment. This is in contrast to other conditions with cardiac hypertrophy. Further studies are required to determine the significance of this novel finding in relation to acromegalic cardiac disease.
Andreassen
Mikkel
M
Department of Endocrinology and Internal Medicine J106, Copenhagen University Hospital Herlev, Denmark. mikand01@heh.regionh.dk
Faber
Jens
J
Vestergaard
Henrik
H
Kistorp
Caroline
C
Kristensen
Lars Østergaard
LØ
D000172:Acromegaly / Q000097:blood* / Q000188:drug therapy / Q000601:surgery; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D013006:Growth Hormone / Q000097:blood / Q000172:deficiency* / Q000627:therapeutic use; D006801:Humans; D018972:Insulin-Like Growth Factor Binding Protein 3 / Q000097:blood; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D015282:Octreotide / Q000627:therapeutic use; D010446:Peptide Fragments / Q000097:blood*; D010456:Peptides, Cyclic / Q000627:therapeutic use; D011498:Protein Precursors / Q000097:blood*; D012189:Retrospective Studies; D013004:Somatostatin / Q000031:analogs & derivatives / Q000627:therapeutic use; D018709:Statistics, Nonparametric
D018931:Antineoplastic Agents, Hormonal; D015415:Biomarkers; D018972:Insulin-Like Growth Factor Binding Protein 3; D010446:Peptide Fragments; D010456:Peptides, Cyclic; D011498:Protein Precursors; C109794:pro-brain natriuretic peptide (1-76); C060347:lanreotide; D020097:Natriuretic Peptide, Brain; D013004:Somatostatin; D007334:Insulin-Like Growth Factor I; D013006:Growth Hormone; D015282:Octreotide