GH replacement improves quality of life and metabolic parameters in cured acromegalic patients with growth hormone deficiency.
OBJECTIVE
Effects of GH replacement in patients with GH deficiency (GHD) after a cure for acromegaly so far have been poorly studied, although its prevalence among acromegalic patients may reach the 60%. The aim of the study was to evaluate whether metabolic parameters and quality of life are improved by GH replacement in patients with prior acromegaly and severe GHD.


METHODS
This was a prospective study on 42 GHD subjects [22 men, mean age (sd): 48 ± 10]: 10 acromegalics treated with recombinant human GH (group A), 12 acromegalics who refused treatment (group B), and 20 subjects operated for nonfunctioning pituitary adenoma on recombinant human GH (group C). Serum IGF-I levels, lipid profile, glucose levels (fasting and after an oral glucose tolerance test), glycosylated hemoglobin, insulin resistance (homeostasis model assessment insulin resistance index), anthropometric parameters (body mass index, waist circumference, body composition), and quality of life (Questions on Life Satisfaction-Hypopituitarism Z-scores) were evaluated at baseline and after 12 and 36 months.


RESULTS
At baseline, group B showed higher IGF sd score than group A and C, as well as better quality of life and higher post-oral glucose tolerance test glucose levels than group A. After 12-months, similarly in group A and C, the IGF-I sd score significantly increased, and body composition and lipid profile improved, without deterioration of glucose tolerance. Quality of life significantly improved too, and the baseline difference between group A and B disappeared. Results were confirmed after 36 months.


CONCLUSIONS
In GHD acromegalic patients, GH therapy improved body composition, lipid profile, and quality of life as in patients with GHD due to nonfunctioning pituitary adenoma, without negative effects on glucose metabolism. GH replacement therapy should be considered in these patients, as in patients with GHD from other causes.
Fondazione Instituto di Ricovero e Cura a Carattere Scientifico Cà Granda Ospedale Maggiore Policlinico, Endocrinology and Diabetology Unit, Via F. Sforza 35, 20122 Milan, Italy. claudiagiavoli@yahoo.it
Claudia
C
Giavoli
Eriselda
E
Profka
Elisa
E
Verrua
Cristina L
CL
Ronchi
Emanuele
E
Ferrante
Silvia
S
Bergamaschi
Elisa
E
Sala
Elena
E
Malchiodi
Andrea G
AG
Lania
Maura
M
Arosio
Bruno
B
Ambrosi
Anna
A
Spada
Paolo
P
Beck-Peccoz
D000172:Acromegaly / Q000097:blood / Q000188:drug therapy* / Q000523:psychology / Q000601:surgery; D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D005260:Female; D020249:Hormone Replacement Therapy / Q000523:psychology*; D019382:Human Growth Hormone / Q000172:deficiency / Q000627:therapeutic use*; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D011994:Recombinant Proteins / Q000627:therapeutic use*; D016896:Treatment Outcome
D001786:Blood Glucose; D008055:Lipids; D011994:Recombinant Proteins; D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I