Effects of GH treatment in GH-deficient adults on adiponectin, leptin and pregnancy-associated plasma protein-A.
OBJECTIVE
GH deficiency (GHD) in adults is associated with adverse effects on metabolism and increased cardiovascular risk. Pregnancy-associated plasma protein-A (PAPP-A) is a protease that promotes IGF-I availability in vascular tissues. PAPP-A levels appear to correlate with carotid intima-media thickness and have been proposed as an early predictor of cardiac events. The aim of our study was to evaluate PAPP-A levels in GHD adults at baseline and after GH replacement and correlate them with changes in body composition, lipid profile, glucose homeostasis, inflammatory markers and in leptin and adiponectin.


METHODS
Fourteen GHD adults were evaluated at baseline and after 1 year of GH therapy. All patients were compared at baseline with 28 age-, sex- and body mass index (BMI)-matched control subjects.


RESULTS
At baseline, GHD adults showed higher PAPP-A levels (P=0.03) and higher leptin (P=0.04), fibrinogen (P=0.002) and highly sensitive C-reactive protein (P=0.01) values than controls. Therapy with GH reduced PAPP-A (P=0.03) and fibrinogen levels (P=0.002) while increased BMI (P=0.01) and reduced waist-hip ratio (WHR; P=0.05) were observed. Insulin and homeostasis model assessment of insulin resistance index increased after treatment (P<0.004/P=0.007), without changes in leptin or adiponectin levels. PAPP-A values correlated positively with BMI and WHR and negatively with adiponectin before and after treatment, with no correlation with glucose homeostasis parameters, lipid profile or leptin.


CONCLUSIONS
Our study suggests that PAPP-A expression is increased in GHD adults, and that 1 year of GH replacement therapy is able to reduce PAPP-A levels in this population. However, further studies are required to determine whether this decrease correlates with an improvement in atherosclerosis.
Joaquin
C
C
Department of Endocrinology, Hospital Universitari Germans Trias i Pujol, Universitat Autonoma de Barcelona, Carretera del Canyet s/n 08916, Badalona, Barcelona, Spain. clara.joaquim@gmail.com
Aguilera
E
E
Granada
M L
ML
Pastor
M C
MC
Salinas
I
I
Alonso
N
N
Sanmartí
A
A
D052242:Adiponectin / Q000097:blood*; D000328:Adult; D001794:Blood Pressure / Q000187:drug effects; D001823:Body Composition / Q000187:drug effects; D005260:Female; D005500:Follow-Up Studies; D005947:Glucose / Q000378:metabolism; D013006:Growth Hormone / Q000627:therapeutic use*; D020249:Hormone Replacement Therapy; D019382:Human Growth Hormone / Q000172:deficiency*; D006801:Humans; D007018:Hypopituitarism / Q000097:blood / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D018836:Inflammation Mediators / Q000097:blood; D020738:Leptin / Q000097:blood*; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D011266:Pregnancy-Associated Plasma Protein-A / Q000378:metabolism*; D012107:Research Design
D052242:Adiponectin; D018836:Inflammation Mediators; D020738:Leptin; D008055:Lipids; D019382:Human Growth Hormone; D013006:Growth Hormone; D011266:Pregnancy-Associated Plasma Protein-A; D005947:Glucose