title: Increased visceral adiposity and cortisol to cortisone ratio in adults with congenital lifetime isolated GH deficiency.
abstract: BACKGROUND
  Adult-onset GH deficiency (GHD) increases visceral adiposity and the activity of the enzyme 11β-hydroxysteroid dehydrogenase, which converts cortisone (E) to cortisol (F), both linked to insulin resistance and increased cardiovascular risk. Conversely, we reported that adults with congenital isolated GHD (IGHD) have increased insulin sensitivity.
  
  
  OBJECTIVE
  To assess the type of fat distribution and the amount of visceral and sc fat and to correlate them to the F/E ratio in adults with untreated IGHD due to a mutation in the GHRH receptor gene.
  
  
  METHODS
  Body composition was assessed by dual-energy x-ray absorptiometry, thickness of sc and visceral fat was measured by sonography, and serum F and E were measured in 23 IGHD subjects and 21 age-matched controls.
  
  
  RESULTS
  Waist/hip ratio (WHR), trunk fat, and trunk/extremity fat (TR/EXT) ratio were higher in IGHD subjects. Visceral fat index (VFI) (but not sc fat index [SFI]) was higher in IGHD. F and F/E ratio were also higher in IGHD. In all 44 individuals, WHR correlated with TR/EXT ratio, thickness of visceral fat, VFI/SFI ratio, F, and F/E ratio. TR/EXT ratio correlated with visceral fat thickness, VFI/SFI ratio, and F. Age had a significant effect on VFI and on F/E ratio. Body mass index SD score and WHR have a similar significant effect on TR/EXT ratio and on F/E ratio.
  
  
  CONCLUSIONS
  Lifetime congenital untreated IGHD causes increased visceral adiposity with a high F/E ratio. However, the increased insulin sensitivity suggests that visceral adiposity needs a minimal GH secretion to translate into increased insulin resistance.
authors.affiliation: Federal University of Sergipe, Divisions of Endocrinology (E.G.-S., C.R.P.O., R.D.C.A.D., J.A.M.S., F.A.P., R.A.A.B. A.H.O.S., E.V.M., C.C.E.-P., A.A.O.-S., I.A.S.O., J.A.M., F.J.S.-J., J.A.S.B.-F., M.H.A.-O.), and Radiology (T.O.F.), Aracaju, SE, Brazil 49060-100; and Division of Endocrinology, Diabetes, and Metabolism (R.S.), The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287.
authors.forename: Elenilde
authors.initials: E
authors.lastname: Gomes-Santos
authors.forename: Roberto
authors.initials: R
authors.lastname: Salvatori
authors.forename: Thiago O
authors.initials: TO
authors.lastname: Ferrão
authors.forename: Carla R P
authors.initials: CR
authors.lastname: Oliveira
authors.forename: Rachel D C A
authors.initials: RD
authors.lastname: Diniz
authors.forename: João A M
authors.initials: JA
authors.lastname: Santana
authors.forename: Francisco A
authors.initials: FA
authors.lastname: Pereira
authors.forename: Rita A A
authors.initials: RA
authors.lastname: Barbosa
authors.forename: Anita H O
authors.initials: AH
authors.lastname: Souza
authors.forename: Enaldo V
authors.initials: EV
authors.lastname: Melo
authors.forename: Carlos C
authors.initials: CC
authors.lastname: Epitácio-Pereira
authors.forename: Alécia A
authors.initials: AA
authors.lastname: Oliveira-Santos
authors.forename: Ingrid A S
authors.initials: IA
authors.lastname: Oliveira
authors.forename: Julianne A
authors.initials: JA
authors.lastname: Machado
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Santana-Júnior
authors.forename: José A S
authors.initials: JA
authors.lastname: Barreto-Filho
authors.forename: Manuel H
authors.initials: MH
authors.lastname: Aguiar-Oliveira
mesh_terms: D000328:Adult; D001823:Body Composition; D050218:Body Fat Distribution; D003348:Cortisone / Q000097:blood*; D003430:Cross-Sectional Studies; D004393:Dwarfism, Pituitary / Q000151:congenital / Q000000981:diagnostic imaging / Q000378:metabolism*; D005260:Female; D019382:Human Growth Hormone / Q000097:blood / Q000172:deficiency*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007333:Insulin Resistance; D050152:Intra-Abdominal Fat / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D050151:Subcutaneous Fat / Q000000981:diagnostic imaging*; D014463:Ultrasonography; D049629:Waist-Hip Ratio
chemical_list: D019382:Human Growth Hormone; D003348:Cortisone; D006854:Hydrocortisone