title: Growth hormone status predicts left ventricular mass in patients after cure of acromegaly.
abstract: BACKGROUND
  Growth hormone excess and growth hormone deficiency (GHD) are both associated with increased cardiovascular morbidity. A specific acromegaly-related cardiomyopathy has been described, characterized in part by increased left ventricular mass (LVM). Growth hormone deficiency is associated with reduced LVM. Following cure of acromegaly with surgery or radiation therapy, GHD may develop; however, its effects on cardiac morphology and function in this population are not established.
  
  
  OBJECTIVE
  We hypothesized that the development of GHD in patients with prior acromegaly would be associated with cardiac morphologic and functional changes that differ from those in patients who are GH sufficient following cure of acromegaly.
  
  
  METHODS
  A cross-sectional study was conducted in a Clinical Research Center. Study participants consisted of three groups of subjects (n=34): I. Cured acromegaly with GHD (n=15), II. Cured acromegaly with GH sufficiency (n=8), and III. Active acromegaly (n=11). Main outcome measures included cardiac morphology and function, using echocardiography parameters.
  
  
  RESULTS
  Mean age and BMI, 44.6 ± 2.3 years (SEM) and 30.7 ± 1.3 kg/m², respectively, were not different among the three groups. Mean peak GH values were: I. 2.8 ± 0.4 ng/ml; II. 30.1 ± 9.1 ng/ml (p=0.0002.) In group I, left ventricular mass, indexed to body surface area (LVMi), was within the normal range in all patients; moreover, left ventricular (LV) geometry was normal. At least 50% of patients in groups II and III had elevated LVMi, and in 50% of patients, LV geometry was abnormal, indicating pathologic hypertrophy. Ejection fraction was similar between all three groups. There were no significant differences in diastolic function.
  
  
  CONCLUSIONS
  Patients who develop GHD following cure of acromegaly do not demonstrate elevated LV mass, in contrast to patients with a history of acromegaly but normal GH levels or to patients with active acromegaly. This suggests that GH status after treatment of acromegaly correlates with LV mass, and that, in GH sufficient patients, reversal of remodeling may be slower than previously thought. These data suggest that it will be important to determine whether GH replacement alters left ventricular morphology over time.
authors.affiliation: Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
authors.forename: Tamara L
authors.initials: TL
authors.lastname: Wexler
authors.forename: Ronen
authors.initials: R
authors.lastname: Durst
authors.forename: David
authors.initials: D
authors.lastname: McCarty
authors.forename: Michael H
authors.initials: MH
authors.lastname: Picard
authors.forename: Lindsay
authors.initials: L
authors.lastname: Gunnell
authors.forename: Zehra
authors.initials: Z
authors.lastname: Omer
authors.forename: Pouneh
authors.initials: P
authors.lastname: Fazeli
authors.forename: Karen K
authors.initials: KK
authors.lastname: Miller
authors.forename: Anne
authors.initials: A
authors.lastname: Klibanski
mesh_terms: D000172:Acromegaly / Q000097:blood / Q000473:pathology* / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D004452:Echocardiography; D005260:Female; D006352:Heart Ventricles / Q000473:pathology*; D019382:Human Growth Hormone / Q000097:blood* / Q000172:deficiency* / Q000378:metabolism; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000097:blood / Q000473:pathology* / Q000628:therapy; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D013318:Stroke Volume / Q000502:physiology; D055815:Young Adult
chemical_list: D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I