title: [Efficacy, safety and compliance of long-term growth hormone (GH) replacement therapy in adults with GH deficiency].
abstract: OBJECTIVE
  To study efficacy, safety and compliance of GH therapy for 4 years in 18 GH deficient (GHD) adults [12 women; mean age 50.5 yrs (25-66 yrs)].
  
  
  METHODS
  Clinical, biochemical and body composition (DXA) measurements were performed before and every year after GH therapy. Ecocardiography was performed at baseline and after 4 years. Dose of GH was 0.2 mg/day during the first year with subsequent titration to attain normal IGF-1 levels.
  
  
  RESULTS
  There was a significant reduction of total body fat (mean 2.8 kg), truncal fat (mean 1.9 kg) and an increase of lean body mass (mean 0.8 kg) and bone mineral density (BMD) on lumbar spine and femur, particularly in sites with T-score<-1,0 at baseline. Insulin levels and HOMA index worsened in the first year, but at the end no changes were noted on glucose, insulin, HOMA index and glycosylated hemoglobin. Two patients with altered glucose tolerance at baseline developed type 2 diabetes during follow-up. Total and LDL-cholesterol were significantly lower after therapy, with changes directly associated with baseline values. Cardiac parameters did not change. Side effects were mild and disappeared spontaneously. Tumor recurrence was not observed. Low compliance (estimated by low IGF-1 levels) was observed in 4 (22%), 2 (11%) and 6 (33%) patients at the end of second, third and fourth year, respectively.
  
  
  CONCLUSIONS
  Four years of GH therapy in GHD adults had a positive impact on body composition, BMD and lipid profile, with no effects on insulin sensitivity and heart. Glucose tolerance should be monitored carefully during long-term GH therapy.
authors.affiliation: Serviço de Endocrinologia e Metabologia do Paraná, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil.
authors.forename: Daniele C T
authors.initials: DC
authors.lastname: Zaninelli
authors.forename: Ludimyla H F
authors.initials: LH
authors.lastname: Meister
authors.forename: Rosana B
authors.initials: RB
authors.lastname: Radominski
authors.forename: Victoria Z C
authors.initials: VZ
authors.lastname: Borba
authors.forename: Admar Moraes
authors.initials: AM
authors.lastname: Souza
authors.forename: Cesar L
authors.initials: CL
authors.lastname: Boguszewski
mesh_terms: D000328:Adult; D001823:Body Composition / Q000187:drug effects*; D015519:Bone Density / Q000187:drug effects; D002318:Cardiovascular Diseases / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D020249:Hormone Replacement Therapy; D019382:Human Growth Hormone / Q000008:administration & dosage* / Q000172:deficiency; D006801:Humans; D007018:Hypopituitarism / Q000188:drug therapy*; D007334:Insulin-Like Growth Factor I / Q000032:analysis*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D055815:Young Adult
chemical_list: D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I