51
|
Wilson CL, Chemaitilly W, Jones KE, Kaste SC, Srivastava DK, Ojha RP, Yasui Y, Pui CH, Robison LL, Hudson MM, Ness KK. Modifiable Factors Associated With Aging Phenotypes Among Adult Survivors of Childhood Acute Lymphoblastic Leukemia. J Clin Oncol 2016; 34:2509-15. [PMID: 27001572 PMCID: PMC4962734 DOI: 10.1200/jco.2015.64.9525] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
PURPOSE Survivors of childhood acute lymphoblastic leukemia (ALL) are at risk for low bone mineral density (BMD) and frail health, outcomes potentially modifiable by altering health behaviors and/or treating endocrine abnormalities. We evaluated associations between lifestyle and hormonal deficits with risk of low BMD and frailty among survivors of ALL. PATIENTS AND METHODS Participants included 862 survivors of ALL (median age, 31.3 years [range, 18.4 to 59.7 years]) enrolled in the St Jude Lifetime Cohort study. Bone density was measured using quantitative computed tomography of L1 through L2 vertebrae; low BMD was defined as an age- and sex-standardized z score < -1. The presence of frailty or prefrailty was defined as having at least two of the following: low muscle mass, self-reported exhaustion, low energy expenditure, slow walking speed, and weakness. Hormonal deficiencies were determined according to medical history, medications, and laboratory findings (insulin-like growth factor 1, follicle-stimulating hormone, luteinizing hormone, and testosterone levels). Logistic regression was used to examine associations between lifestyle (smoking, alcohol consumption, and activity levels) and deficiencies in growth hormone (GHD) and/or sex steroids with low BMD and frailty. RESULTS Thirty percent of survivors met criteria for low BMD, and 18.6% for frailty/prefrailty. After adjusting for body mass index, low BMD was associated with GHD (odds ratio [OR], 1.59; 95% CI, 1.02 to 2.13) and current smoking (OR, 1.71; 95% CI, 1.02 to 2.85) among men; and GHD (OR, 2.18; 95% CI, 1.26 to 3.78) and moderate alcohol consumption (OR, 2.09; 95% CI, 1.14 to 3.83) among women. After adjusting for current age, the odds of frailty/prefrailty were increased among men with GHD (OR, 2.97; 95% CI, 1.56 to 5.67) and those who smoked (OR, 3.26; 95% CI, 1.65 to 6.43); there were no significant associations among women. CONCLUSION The findings suggest that survivors of ALL should receive counseling regarding lifestyle and undergo screening for hormonal deficits to minimize the risk of low BMD and frailty.
Collapse
Affiliation(s)
- Carmen L Wilson
- Carmen L. Wilson, Wassim Chemaitilly, Kendra E. Jones, Sue C. Kaste, Deo Kumar Srivastava, Rohit P. Ojha, Yutaka Yasui, Ching-Hon Pui, Leslie L. Robison, Melissa M. Hudson, and Kirsten K. Ness, St Jude Children's Research Hospital; Sue C. Kaste and Ching-Hon Pui, University of Tennessee Health Sciences Center, Memphis, TN.
| | - Wassim Chemaitilly
- Carmen L. Wilson, Wassim Chemaitilly, Kendra E. Jones, Sue C. Kaste, Deo Kumar Srivastava, Rohit P. Ojha, Yutaka Yasui, Ching-Hon Pui, Leslie L. Robison, Melissa M. Hudson, and Kirsten K. Ness, St Jude Children's Research Hospital; Sue C. Kaste and Ching-Hon Pui, University of Tennessee Health Sciences Center, Memphis, TN
| | - Kendra E Jones
- Carmen L. Wilson, Wassim Chemaitilly, Kendra E. Jones, Sue C. Kaste, Deo Kumar Srivastava, Rohit P. Ojha, Yutaka Yasui, Ching-Hon Pui, Leslie L. Robison, Melissa M. Hudson, and Kirsten K. Ness, St Jude Children's Research Hospital; Sue C. Kaste and Ching-Hon Pui, University of Tennessee Health Sciences Center, Memphis, TN
| | - Sue C Kaste
- Carmen L. Wilson, Wassim Chemaitilly, Kendra E. Jones, Sue C. Kaste, Deo Kumar Srivastava, Rohit P. Ojha, Yutaka Yasui, Ching-Hon Pui, Leslie L. Robison, Melissa M. Hudson, and Kirsten K. Ness, St Jude Children's Research Hospital; Sue C. Kaste and Ching-Hon Pui, University of Tennessee Health Sciences Center, Memphis, TN
| | - Deo Kumar Srivastava
- Carmen L. Wilson, Wassim Chemaitilly, Kendra E. Jones, Sue C. Kaste, Deo Kumar Srivastava, Rohit P. Ojha, Yutaka Yasui, Ching-Hon Pui, Leslie L. Robison, Melissa M. Hudson, and Kirsten K. Ness, St Jude Children's Research Hospital; Sue C. Kaste and Ching-Hon Pui, University of Tennessee Health Sciences Center, Memphis, TN
| | - Rohit P Ojha
- Carmen L. Wilson, Wassim Chemaitilly, Kendra E. Jones, Sue C. Kaste, Deo Kumar Srivastava, Rohit P. Ojha, Yutaka Yasui, Ching-Hon Pui, Leslie L. Robison, Melissa M. Hudson, and Kirsten K. Ness, St Jude Children's Research Hospital; Sue C. Kaste and Ching-Hon Pui, University of Tennessee Health Sciences Center, Memphis, TN
| | - Yutaka Yasui
- Carmen L. Wilson, Wassim Chemaitilly, Kendra E. Jones, Sue C. Kaste, Deo Kumar Srivastava, Rohit P. Ojha, Yutaka Yasui, Ching-Hon Pui, Leslie L. Robison, Melissa M. Hudson, and Kirsten K. Ness, St Jude Children's Research Hospital; Sue C. Kaste and Ching-Hon Pui, University of Tennessee Health Sciences Center, Memphis, TN
| | - Ching-Hon Pui
- Carmen L. Wilson, Wassim Chemaitilly, Kendra E. Jones, Sue C. Kaste, Deo Kumar Srivastava, Rohit P. Ojha, Yutaka Yasui, Ching-Hon Pui, Leslie L. Robison, Melissa M. Hudson, and Kirsten K. Ness, St Jude Children's Research Hospital; Sue C. Kaste and Ching-Hon Pui, University of Tennessee Health Sciences Center, Memphis, TN
| | - Leslie L Robison
- Carmen L. Wilson, Wassim Chemaitilly, Kendra E. Jones, Sue C. Kaste, Deo Kumar Srivastava, Rohit P. Ojha, Yutaka Yasui, Ching-Hon Pui, Leslie L. Robison, Melissa M. Hudson, and Kirsten K. Ness, St Jude Children's Research Hospital; Sue C. Kaste and Ching-Hon Pui, University of Tennessee Health Sciences Center, Memphis, TN
| | - Melissa M Hudson
- Carmen L. Wilson, Wassim Chemaitilly, Kendra E. Jones, Sue C. Kaste, Deo Kumar Srivastava, Rohit P. Ojha, Yutaka Yasui, Ching-Hon Pui, Leslie L. Robison, Melissa M. Hudson, and Kirsten K. Ness, St Jude Children's Research Hospital; Sue C. Kaste and Ching-Hon Pui, University of Tennessee Health Sciences Center, Memphis, TN
| | - Kirsten K Ness
- Carmen L. Wilson, Wassim Chemaitilly, Kendra E. Jones, Sue C. Kaste, Deo Kumar Srivastava, Rohit P. Ojha, Yutaka Yasui, Ching-Hon Pui, Leslie L. Robison, Melissa M. Hudson, and Kirsten K. Ness, St Jude Children's Research Hospital; Sue C. Kaste and Ching-Hon Pui, University of Tennessee Health Sciences Center, Memphis, TN
| |
Collapse
|
52
|
Dietary Protein Intake and Lean Muscle Mass in Survivors of Childhood Acute Lymphoblastic Leukemia: Report From the St. Jude Lifetime Cohort Study. Phys Ther 2016; 96:1029-38. [PMID: 26893509 PMCID: PMC4935785 DOI: 10.2522/ptj.20150507] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 01/26/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Survivors of childhood acute lymphoblastic leukemia (ALL) are at risk for low lean muscle mass and muscle weakness, which may contribute to inactivity and early development of chronic diseases typically seen in older adults. Although increasing protein intake, in combination with resistance training, improves lean muscle mass in other populations, it is not known whether muscular tissue among survivors of ALL, whose impairments are treatment-related, will respond similarly. OBJECTIVE The aim of this study was to evaluate associations among dietary protein intake, resistance training, and lean muscle mass in survivors of ALL and age-, sex-, and race-matched controls. DESIGN This was a cross-sectional study. METHODS Lean muscle mass was determined with dual-energy x-ray absorptiometry, dietary information with 24-hour recalls, and participation in resistance training with a questionnaire. Participants were 365 survivors of ALL (52% male; 87% white; median age=28.5 years, range=23.6-31.7) and 365 controls with no previous cancer. RESULTS Compared with controls, survivors of ALL had lower lean muscle mass (55.0 versus 57.2 kg, respectively) and lower percentage of lean muscle mass (68.6% versus 71.4%, respectively) than controls. Similar proportions of survivors (71.1%) and controls (69.7%) met recommended dietary protein intake (0.8 g/kg/d). Survivors (45.4%) were less likely to report resistance training than controls (53.8%). In adjusted models, 1-g higher protein intake per kilogram of body mass per day was associated with a 7.9% increase and resistance training ≥1×wk, with a 2.8% increase in lean muscle mass. LIMITATIONS The cross-sectional study design limits temporal evaluation of the association between protein intake and lean muscle mass. CONCLUSIONS The findings suggest that survivors of childhood ALL with low lean muscle mass may benefit from optimizing dietary protein intake in combination with resistance training. Research is needed to determine whether resistance training with protein supplementation improves lean muscle mass in survivors of childhood ALL.
Collapse
|
53
|
Liang S, Hu Y, Liu C, Qi J, Li G. Low insulin-like growth factor 1 is associated with low high-density lipoprotein cholesterol and metabolic syndrome in Chinese nondiabetic obese children and adolescents: a cross-sectional study. Lipids Health Dis 2016; 15:112. [PMID: 27343122 PMCID: PMC4919831 DOI: 10.1186/s12944-016-0275-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 06/15/2016] [Indexed: 01/12/2023] Open
Abstract
Background Low serum high-density lipoprotein cholesterol (HDL-C) is an independent risk factor for developing cardiovascular disease. Insulin-like growth factor 1(IGF-1) levels have been proven to be positively associated with HDL-C, but few studies were based on the dataset of children or adolescents. The aim of this study is to investigate the relationship among IGF-1, HDL-C and the metabolic syndrome in Chinese nondiabetic obese children and adolescents. Methods As a cross-sectional study, this study includes 120 obese Chinese children and adolescents and 120 healthy ones. The obese subjects were divided into two groups based on using 1.03 mmol/L as a threshold value for HDL-C. Clinical examination and laboratory examinations were assessed for all participants. Results Obese subjects had significantly lower IGF-1SDS and higher Height SDS than those in the control group. Among 120 obese children and adolescents, 22 (18.3 %) subjects had an HDL-C level <1.03 mmol/L. IGF-1SDS was significantly lower (P = 0.001) in obese subjects with low HDL-C. According to the results of multivariate logistic regression analysis, IGF-1 SDS is significantly associated with low HDL-C(OR 0.518, 95 % CI 0.292–0.916; P = 0.024), after being adjusted for age, gender, pubertal status, BMI SDS, SBP, DBP, HOMR-IR, total cholesterol, low density lipoprotein-cholesterol, triglycerides, ALT and uric acid. In addition, IGF-1 SDS is significantly correlated with the level of serum HDL-C in study population (r = 0.19, P = 0.003). Based on logistic regression analysis with adjustment for age, gender and pubertal status, the increased IGF-1 SDS was associated with a decreased probability of metabolic syndrome (OR 0.555, 95 % CI 0.385–0.801; P = 0.002) and hypertriglyceridemia (OR 0.582, 95 % CI 0.395–0.856; P = 0.006), but no significant correlation with hypertension. Conclusion Obese children had lower IGF-1SDS and taller stature compared with the control group. Low levels of IGF-1 SDS were associated with low levels of HDL-C in chinese nondiabetic obese children and adolescents, independent of insulin resistance, as well as other traditional cardiovascular disease risk markers.
Collapse
Affiliation(s)
- Shuang Liang
- Department of Pediatrics, Shandong Provincial Hospital Affiliated to Shandong University, 9677 Jingshi Road, Jinan, 250021, China
| | - Yanyan Hu
- Department of Pediatrics, Shandong Provincial Hospital Affiliated to Shandong University, 9677 Jingshi Road, Jinan, 250021, China
| | - Caihong Liu
- Department of Pediatrics, Shandong Provincial Hospital Affiliated to Shandong University, 9677 Jingshi Road, Jinan, 250021, China
| | - Jianhong Qi
- Department of Pediatrics, Shandong Provincial Hospital Affiliated to Shandong University, 9677 Jingshi Road, Jinan, 250021, China
| | - Guimei Li
- Department of Pediatrics, Shandong Provincial Hospital Affiliated to Shandong University, 9677 Jingshi Road, Jinan, 250021, China.
| |
Collapse
|
54
|
Melmed S. Pituitary Medicine From Discovery to Patient-Focused Outcomes. J Clin Endocrinol Metab 2016; 101:769-77. [PMID: 26908107 PMCID: PMC4803158 DOI: 10.1210/jc.2015-3653] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 12/27/2015] [Indexed: 12/14/2022]
Abstract
CONTEXT This perspective traces a pipeline of discovery in pituitary medicine over the past 75 years. OBJECTIVE To place in context past advances and predict future changes in understanding pituitary pathophysiology and clinical care. DESIGN Author's perspective on reports of pituitary advances in the published literature. SETTING Clinical and translational Endocrinology. OUTCOMES Discovery of the hypothalamic-pituitary axis and mechanisms for pituitary control, have culminated in exquisite understanding of anterior pituitary cell function and dysfunction. Challenges facing the discipline include fundamental understanding of pituitary adenoma pathogenesis leading to more effective treatments of inexorably growing and debilitating hormone secreting pituitary tumors as well as medical management of non-secreting pituitary adenomas. Newly emerging pituitary syndromes include those associated with immune-targeted cancer therapies and head trauma. CONCLUSIONS Novel diagnostic techniques including imaging genomic, proteomic, and biochemical analyses will yield further knowledge to enable diagnosis of heretofore cryptic syndromes, as well as sub classifications of pituitary syndromes for personalized treatment approaches. Cost effective personalized approaches to precision therapy must demonstrate value, and will be empowered by multidisciplinary approaches to integrating complex subcellular information to identify therapeutic targets for enabling maximal outcomes. These goals will be challenging to attain given the rarity of pituitary disorders and the difficulty in conducting appropriately powered prospective trials.
Collapse
Affiliation(s)
- Shlomo Melmed
- Cedars-Sinai Medical Center, Los Angeles, California 90048
| |
Collapse
|
55
|
Allensworth-James ML, Odle A, Haney A, Childs G. Sex Differences in Somatotrope Dependency on Leptin Receptors in Young Mice: Ablation of LEPR Causes Severe Growth Hormone Deficiency and Abdominal Obesity in Males. Endocrinology 2015; 156:3253-64. [PMID: 26168341 PMCID: PMC4541611 DOI: 10.1210/en.2015-1198] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Leptin receptor (LEPR) signaling controls appetite and energy expenditure. Somatotrope-specific deletion of the LEPRb signaling isoform causes GH deficiency and obesity. The present study selectively ablated Lepr exon 1 in somatotropes, which removes the signal peptide, causing the loss of all isoforms of LEPR. Excision of Lepr exon 1 was restricted to the pituitary, and mutant somatotropes failed to respond to leptin. Young (2-3 mo) males showed a severe 84% reduction in serum GH levels and more than 60% reduction in immunolabeled GH cells compared with 41%-42% reductions in GH and GH cells in mutant females. Mutant males (35 d) and females (45 d) weighed less than controls and males had lower lean body mass. Image analysis of adipose tissue by magnetic resonance imaging showed that young males had a 2-fold increase in abdominal fat mass and increased adipose tissue density. Young females had only an overall increase in adipose tissue. Both males and females showed lower energy expenditure and higher respiratory quotient, indicating preferential carbohydrate burning. Young mutant males slept less and were more restless during the dark phase, whereas the opposite was true of females. The effects of a Cre-bearing sire on his non-Cre-recombinase bearing progeny are seen by increased respiratory quotient and reduced litter sizes. These studies elucidate clear sex differences in the extent to which somatotropes are dependent on all isoforms of LEPR. These results, which were not seen with the ablation of Lepr exon 17, highlight the severe consequences of ablation of LEPR in male somatotropes.
Collapse
Affiliation(s)
- Melody L Allensworth-James
- Department of Neurobiology and Developmental Sciences, College of Medicine University of Arkansas for Medical Sciences, Little Rock, Arkansas 72212
| | - Angela Odle
- Department of Neurobiology and Developmental Sciences, College of Medicine University of Arkansas for Medical Sciences, Little Rock, Arkansas 72212
| | - Anessa Haney
- Department of Neurobiology and Developmental Sciences, College of Medicine University of Arkansas for Medical Sciences, Little Rock, Arkansas 72212
| | - Gwen Childs
- Department of Neurobiology and Developmental Sciences, College of Medicine University of Arkansas for Medical Sciences, Little Rock, Arkansas 72212
| |
Collapse
|
56
|
Stochholm K, Johannsson G. Reviewing the safety of GH replacement therapy in adults. Growth Horm IGF Res 2015; 25:149-157. [PMID: 26117668 DOI: 10.1016/j.ghir.2015.06.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 06/17/2015] [Accepted: 06/17/2015] [Indexed: 02/04/2023]
Abstract
CONTEXT Systematic data on safety of growth hormone (GH) replacement therapy in adult GH deficiency is lacking. OBJECTIVE To systematically describe safety of adult GH replacement therapy on glucose metabolism and long term safety. DESIGN A systematic web-based search of PubMed was performed guided by the Standard Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). OUTCOME Randomised controlled trials of ≥3 months and open trials for ≥12 months with more than 50 adult patients (50 patient years, prospective and retrospective) including adverse event reporting as well as articles on mortality primarily on adult onset patients, reporting mortality ratios on GH treated patients, were included for the review. RESULTS Based on the defined selection criteria 94 studies were included. The short-term early placebo controlled trials did not demonstrate an increased frequency of diabetes mellitus (DM) and the long-term open studies did not consistently show an increased incidence of DM during GH replacement. The concern that long-term GH replacement might increase the risk of primary cancer, secondary neoplasia after tumour treatment and recurrence of previous tumours was not evident in the study data. CONCLUSION Based on available data, short- and long-term adult GH replacement in patients with severe GH deficiency and hypopituitarism is safe. However, the small number of subjects, limitation of long-term of GH treatment data and absence of an adequate control population is still a limitation for the interpretation of these data.
Collapse
Affiliation(s)
- Kirstine Stochholm
- Department of Internal Medicine and Endocrinology, Aarhus University Hospital, 8000, Aarhus C, Denmark
| | - Gudmundur Johannsson
- Department of Endocrinology, Grstr 8, Sahlgrenska University Hospital, SE-413 45 Göteborg, Sweden; Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Göteborg, Grstr 8, Sahlgrenska University Hospital, SE-413 45 Göteborg, Sweden
| |
Collapse
|
57
|
Isgaard J, Arcopinto M, Karason K, Cittadini A. GH and the cardiovascular system: an update on a topic at heart. Endocrine 2015; 48:25-35. [PMID: 24972804 PMCID: PMC4328125 DOI: 10.1007/s12020-014-0327-6] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 06/04/2014] [Indexed: 01/06/2023]
Abstract
In this review, the importance of growth hormone (GH) for the maintenance of normal cardiac function in adult life is discussed. Physiological effects of GH and underlying mechanisms for interactions between GH and insulin-like growth factor I (IGF-I) and the cardiovascular system are covered as well as the cardiac dysfunction caused both by GH excess (acromegaly) and by GH deficiency in adult hypopituitary patients. In both acromegaly and adult GH deficiency, there is also increased cardiovascular morbidity and mortality possibly linked to aberrations in GH status. Finally, the status of the GH/IGF-I system in relation to heart failure and the potential of GH as a therapeutic tool in the treatment of heart failure are reviewed in this article.
Collapse
Affiliation(s)
- Jörgen Isgaard
- Laboratory of Experimental Endocrinology, Department of Internal Medicine, Sahlgrenska Academy, University of Gothenburg, Gröna Stråket 8, 413 45, Göteborg, Sweden,
| | | | | | | |
Collapse
|
58
|
Höybye C, Christiansen JS. Growth hormone replacement in adults - current standards and new perspectives. Best Pract Res Clin Endocrinol Metab 2015; 29:115-23. [PMID: 25617177 DOI: 10.1016/j.beem.2014.09.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Growth hormone deficiency (GHD) in adults is an established clinical syndrome characterised by adverse body composition with more body fat than lean body mass, unfavourable blood lipids, decreased physical fitness and poor quality of life. No specific biomarker for GHD exists and the sometimes difficult diagnosis should be made in accordance with, established guidelines. Measurements of insulin-like growth factor I (IGF-I) is often not sufficient for the diagnosis and stimulation tests of the GH reserve are required. After diagnosis of GHD, treatment with GH should be initiated with a low dose, and gradually increased aiming at obtaining an IGF-I level within the upper part of the normal range for age matched healthy controls. Most side effects are mild and transient and attenuated by gradual dose increments. Numerous studies have shown that GH treatment can improve body composition, cardiovascular risk factors, physical capacity and quality of life. However, studies on effects beyond 5 years are few and despite encouraging preliminary reports the ultimate endpoint demonstrating that GH treatment has beneficial effects on mortality, cardiovascular events and fractures without an increase in cancer incidence remain to be solidly demonstrated and studies to resolve these issues are awaited. Trials with long acting GH formulations are ongoing and available data indicate similar effects on outcome measures compared to the effects of daily injections. This review will give an overview of clinically relevant issues of GHD including advice for management of these patients.
Collapse
Affiliation(s)
- Charlotte Höybye
- Department of Endocrinology, Metabolism and Diabetology, Karolinska University Hospital, Stockholm, Sweden
| | | |
Collapse
|
59
|
Manhylova TA, Gafarova NH. Metabolic and hemodynamic effects of the growth hormone system — insulin-like growth factor. TERAPEVT ARKH 2015; 87:128-133. [DOI: 10.17116/terarkh20158712128-133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
60
|
Giovannini L, Tirabassi G, Muscogiuri G, Di Somma C, Colao A, Balercia G. Impact of adult growth hormone deficiency on metabolic profile and cardiovascular risk [Review]. Endocr J 2015; 62:1037-48. [PMID: 26300280 DOI: 10.1507/endocrj.ej15-0337] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Adult growth hormone deficiency (GHD) is a well defined clinical condition, which is characterized by abnormal body composition, impaired physical activity and decreased quality of life. In addition, in recent years, growing interest has been shown towards cardiovascular risks in adult patients affected by GHD. In this regard, GHD is widely known to be associated with increased mortality, likely due to the increase of risk factors, such as central obesity, impaired lipid and glucose profiles and other less-known risk factors, such as inflammatory cytokines, endothelial dysfunction and oxidative stress. However, very few papers have recently discussed this topic. In this review, the aim is to clarify this issue by discussing evidence regarding the effects of adult GHD on metabolic and cardiovascular profiles.
Collapse
Affiliation(s)
- Lara Giovannini
- Division of Endocrinology, Department of Clinical and Molecular Sciences, Umberto I Hospital, School of Medicine, Polytechnic University of Marche, Ancona, Italy
| | | | | | | | | | | |
Collapse
|
61
|
Akturk IF, Biyik I, Yalcin AA, Isiksacan N, Celik O, Ozturk D, Erturk M. Impact of insulin like growth factor-1 in development of coronary artery ectasia. Bosn J Basic Med Sci 2014; 14:244-9. [PMID: 25428678 PMCID: PMC4333962 DOI: 10.17305/bjbms.2014.4.35] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 07/23/2014] [Indexed: 12/13/2022] Open
Abstract
Coronary artery ectasia (CAE) is characterized by inappropriate dilatation of the coronary vasculature. The mechanisms of CAE are not well known. Insulin-like growth factor-1 (IGF-1) may make endothelial cells and smooth muscle cells more sensitive to the effects of growth hormone. In the present study, we hypothesized that IGF-1 may have an impact on the formation of ectasia and aneurysm in arterial system, and aimed to investigate the associations between the presence of CAE and serum IGF-1 levels in patients undergoing coronary angiography. The study included 2.980 subjects undergoing elective diagnostic coronary angiography. We selected 40 patients diagnosed with CAE as CAE group and 44 subjects with absolutely normal coronary arteries were assigned as normal control group. IGF-1 levels were measured in both groups of patients. Groups were similar in terms of age, sex and coronary artery disease risk factors. The serum IGF-1 levels were significantly higher in CAE patients with 109.64 ± 54.64 ng/mL than in controls with 84.76 ± 34.01 ng/mL (p=0.016). HDL levels were lower in ectasia group with 41.5 ± 10.7 mg/dL than controls with 47.7 ± 10.4 mg/dL (p=0.018). By means of logistic regression analysis, high IGF-1 and low HDL levels were found to be independent risk factors for the presence of CAE (p<0.02, p<0.016, respectively). The study revealed that there was a positive correlation between serum IGF-1 levels and presence of CAE, and high IGF-1 levels and low HDL levels were independent risk factors for the presence of CAE. Future studies are needed to confirm these results.
Collapse
Affiliation(s)
- Ibrahim Faruk Akturk
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ismail Biyik
- Department of Cardiology, Usak State Hospital, Usak, Turkey
| | - Ahmet Arif Yalcin
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Nilgun Isiksacan
- Department of Biochemistry, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Omer Celik
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Derya Ozturk
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Erturk
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
62
|
Abdi L, Sahnoun-Fathallah M, Morange I, Albarel F, Castinetti F, Giorgi R, Brue T. A monocentric experience of growth hormone replacement therapy in adult patients. ANNALES D'ENDOCRINOLOGIE 2014; 75:176-83. [DOI: 10.1016/j.ando.2014.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 05/05/2014] [Accepted: 05/13/2014] [Indexed: 10/25/2022]
|
63
|
Capalbo D, Mattace Raso G, Esposito A, Di Mase R, Barbieri F, Meli R, Bruzzese D, Salerno M. Cluster of cardiometabolic risk factors in children with GH deficiency: a prospective, case-control study. Clin Endocrinol (Oxf) 2014; 80:856-62. [PMID: 24372071 DOI: 10.1111/cen.12393] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 06/23/2013] [Accepted: 12/07/2013] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Growth hormone (GH) deficiency (GHD) in adults is associated with increased cardiovascular (CV) risk. Although some authors have documented the presence of early CV risk factors in untreated GHD children, results are still inconsistent. Aim of this study was to evaluate the effects of GHD and GH therapy on early cardiometabolic risk factors in a large cohort of children. SUBJECTS AND METHODS Waist-to-height ratio (WHtR), triglycerides, total-, low-density lipoprotein (LDL), high-density lipoprotein (HDL) cholesterol, atherogenic index (AI = total /HDL cholesterol), homocysteine, leptin, adiponectin, high-sensitivity C-reactive protein (hsCRP) and fibrinogen were evaluated in seventy-one GHD children (9·8 ± 3·6 years) before and after 2 years of GH therapy. Seventy-one healthy controls comparable with patients for age, sex and body mass index (BMI) were enrolled. RESULTS Compared with controls, GHD children at study entry had higher WHtR (0·52 ± 0·05 vs 0·45 ± 0·19, P = 0·004), triglycerides (0·44 ± 0·98 vs -0·03 ± 0·73 SDS, P = 0·012), total cholesterol (0·28 ± 1·08 vs -0·46 ± 0·98 SDS, P < 0·001), LDL cholesterol (0·20 ± 0·90 vs -0·39 ± 1·06 SDS, P = 0·007), AI (3·19 ± 0·73 vs 2·77 ± 0·53, P = 0·001), homocysteine (8·45 ± 1·8 vs 7·72 ± 1·6 μm, P = 0·003), leptin (8·03 ± 4·2 vs 5·09 ± 1·9 ng/ml, P = 0·001) and fibrinogen (292·6 ± 33 vs 268 ± 31·4 mg/dl, P = 0·011). No differences were found in adiponectin or hsCRP. GH therapy was associated with a significant reduction in WHtR (P < 0·001), total cholesterol (P < 0·001), LDL cholesterol (P = 0·002), homocysteine (P = 0·044) leptin (P = 0·022) and fibrinogen (P = 0·001). Moreover, GH therapy was associated with a significant increase in adiponectin levels (P = 0·001). CONCLUSIONS Our data suggest that children with untreated GHD exhibit a cluster of early cardiovascular risk factors and that GH treatment exerts beneficial effects on these abnormalities.
Collapse
Affiliation(s)
- Donatella Capalbo
- Pediatric Endocrinology Unit, Department of Translational Medical Sciences, University "Federico II" of Naples, Naples, Italy
| | | | | | | | | | | | | | | |
Collapse
|
64
|
Clemmons DR, Molitch M, Hoffman AR, Klibanski A, Strasburger CJ, Kleinberg DL, Ho K, Webb SM, Bronstein MD, Bouillon R, Ben-Shlomo A, Hamrahian AH, Chanson P, Barkan AL, Merriam GR, Blackman MR, Salvatori R. Growth hormone should be used only for approved indications. J Clin Endocrinol Metab 2014; 99:409-11. [PMID: 24423315 PMCID: PMC5393472 DOI: 10.1210/jc.2013-4187] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- David R Clemmons
- University of North Carolina School of Medicine (D.R.C.), Chapel Hill, North Carolina 27594; Northwestern University (M.M.), Chicago, Illinois 60611; VA Palo Alto Heath Care System (A.R.H.), Palo Alto, California 94304; Massachusetts General Hospital (A.K.), Boston, Massachusetts 02114; Charite Medical Faculty Berlin (C.J.S.), Germany D-10187; New York School of Medicine (D.L.K.), New York, New York 10016; Princess Alexandra Hospital (K.H.), Brisbane, Australia 4102; Autonomous University of Barcelona (S.M.W.), Barcelona, Spain; Hospital das Clinicas (M.D.B.), Sao Paula, Brazil; Gasthuisberg Campus; Katholieke Universitat (R.B.), Leuven, Belgium; Cedars Sinai Health Center (A.B.-S.), Los Angeles, California 96048; Cleveland Clinic Foundation (A.M.H.), Cleveland, Ohio 44195; Hôpitaux Universitaires Paris-Sud (P.C.), Le Kremlin Bicêtre F-94275, France; University of Michigan Medical Center (A.L.B.), Ann Arbor, Michigan 48109; University of Washington (G.R.M.), Seattle, Washington 98195; Veterans Administration Medical Center (M.R.B.), Washington, DC 20427; and Johns Hopkins School of Medicine (R.S.), Baltimore, Maryland 21287
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
65
|
Chemaitilly W, Hudson MM. Update on endocrine and metabolic therapy-related late effects observed in survivors of childhood neoplasia. Curr Opin Endocrinol Diabetes Obes 2014; 21:71-6. [PMID: 24275618 DOI: 10.1097/med.0000000000000029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE OF REVIEW To provide a summary of the most recent research pertaining to the endocrine and metabolic complications observed in childhood cancer survivors. RECENT FINDINGS Data on prevalence and risk associations are increasingly available from large cohorts of childhood cancer survivors. New directions in research include novel risk-prediction strategies and the study of genetic predisposition. SUMMARY Endocrine complications are observed in more than 50% of adult childhood cancer survivors. Some continue to develop decades following cancer treatment exposures. The present review provides a summary of the most recent outcomes research pertaining to growth, thyroid, gonadal-reproductive, bone and body composition with emphasis on new directions and challenges in each area.
Collapse
Affiliation(s)
- Wassim Chemaitilly
- aDepartment of Pediatric Medicine - Division of Endocrinology bDepartment of Epidemiology and Cancer Control cDepartment of Oncology-Division of Survivorship3, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | | |
Collapse
|
66
|
Díez JJ, Cordido F. [Benefits and risks of growth hormone in adults with growth hormone deficiency]. Med Clin (Barc) 2014; 143:354-9. [PMID: 24485161 DOI: 10.1016/j.medcli.2013.11.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 10/31/2013] [Accepted: 11/14/2013] [Indexed: 11/17/2022]
Abstract
Adult growth hormone (GH) deficiency is a well-recognized clinical syndrome with adverse health consequences. Many of these may improve after replacement therapy with recombinant GH. This treatment induces an increase in lean body mass and a decrease in fat mass. In long-term studies, bone mineral density increases and muscle strength improves. Health-related quality of life tends to increase after treatment with GH. Lipid profile and markers of cardiovascular risk also improve with therapy. Nevertheless, GH replacement therapy is not without risk. According to some studies, GH increases blood glucose, body mass index and waist circumference and may promote long-term development of diabetes and metabolic syndrome. Risk of neoplasia does not appear to be increased in adults treated with GH, but there are some high-risk subgroups. Methodological shortcomings and difficulties inherent to long-term studies prevent definitive conclusions about the relationship between GH and survival. Therefore, research in this field should remain active.
Collapse
Affiliation(s)
- Juan J Díez
- Servicio de Endocrinología, Hospital Ramón y Cajal, Universidad de Alcalá de Henares, Madrid, España.
| | - Fernando Cordido
- Servicio de Endocrinología, Complejo Hospitalario Universitario de A Coruña, Departamento de Medicina, Universidad de A Coruña, A Coruña, España
| |
Collapse
|
67
|
Elbornsson M, Götherström G, Bengtsson BÅ, Johannsson G, Svensson J. Baseline characteristics and effects of ten years of growth hormone (GH) replacement therapy in adults previously treated with pituitary irradiation. Growth Horm IGF Res 2013; 23:249-255. [PMID: 24103227 DOI: 10.1016/j.ghir.2013.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 09/04/2013] [Accepted: 09/04/2013] [Indexed: 11/19/2022]
Abstract
CONTEXT Little is known of the importance of previous irradiation therapy for baseline characteristics and responsiveness to GH replacement in GH deficient (GHD) adults. OBJECTIVE/DESIGN/PATIENTS In this prospective, single-centre, open-label study, the effects of 10-year GH replacement were determined in 18 GHD adults that had previously received conventional external fractionated pituitary irradiation therapy (IRR group) and 18 non-irradiated GHD patients (non-IRR group). All patients had adult onset disease and complete deficiency of anterior pituitary hormones and both groups were comparable in terms of age, gender, body mass index (BMI), and waist:hip ratio. RESULTS At baseline, IRR patients had higher serum triglyceride (TG) and insulin levels and lower high density lipoprotein (HDL)-cholesterol (HDL-C) level than non-IRR patients (all p<0.05). The 10-year GH replacement improved body composition, bone mass and serum lipid profile without any between-group differences, except for a marginally more beneficial response in serum TG level in the IRR patients. After 10 years, there was no between-group difference in any variable after correction for a higher replacement dose of glucocorticoids in the IRR patients at study end using an analysis of covariance. During the 10-year GH replacement, 5 IRR patients suffered from vascular events (2 fatal) whereas only one non-fatal vascular event occurred in the non-IRR patients. CONCLUSIONS IRR patients with GHD display a more severely impaired cardiovascular risk profile at baseline, which was reversed by the 10-year GH replacement after correction for the higher glucocorticoid dose at study end. However, vascular events occurred more frequently in the IRR patients.
Collapse
Affiliation(s)
- Mariam Elbornsson
- Department of Endocrinology, Gröna Stråket 8, Sahlgrenska University Hospital, SE-413 45 Göteborg, Sweden.
| | | | | | | | | |
Collapse
|
68
|
Abstract
PURPOSE OF REVIEW Animals born with a deficiency in the cell surface receptor for growth hormone (GH) have a significantly reduced risk of developing cancer. Conversely, increased expression levels of GH and the GH receptor (GHR) are detectable in a variety of different human cancers. Here we discuss recent literature contributing to our understanding of the field. RECENT FINDINGS In addition to animal evidence, studies of individuals with Laron syndrome suggest that congenital GHR deficiency may also protect humans against cancer. GH expression in certain malignancies is correlated with clinicohistopathological parameters and may contribute the therapeutic resistance. Other recent studies have identified novel aspects of the GH signal transduction pathway, including receptor crosstalk and the involvement of microRNA in endocrine regulation of GH. SUMMARY Substantial evidence suggests the GH/insulin-like growth factor-1 axis initiates and promotes progression of cancer. However, important questions remain unanswered regarding the therapeutic utility of GH or GHR antagonism in cancer. Further clinical studies regarding the clinical association of GH expression with human malignancies and translational studies investigating GHR antagonism in animal models of human cancer are critical.
Collapse
Affiliation(s)
- Jo K Perry
- Liggins Institute, University of Auckland, Auckland, New Zealand.
| | | | | | | | | |
Collapse
|
69
|
Abstract
Secretion of growth hormone (GH), and consequently that of insulin-like growth factor 1 (IGF-1), declines over time until only low levels can be detected in individuals aged ≥60 years. This phenomenon, which is known as the 'somatopause', has led to recombinant human GH being widely promoted and abused as an antiageing drug, despite lack of evidence of efficacy. By contrast, several mutations that decrease the tone of the GH/IGF-1 axis are associated with extended longevity in mice. In humans, corresponding or similar mutations have been identified, but whether these mutations alter longevity has yet to be established. The powerful effect of reduced GH activity on lifespan extension in mice has generated the hypothesis that pharmaceutically inhibiting, rather than increasing, GH action might delay ageing. Moreover, mice as well as humans with reduced activity of the GH/IGF-1 axis are protected from cancer and diabetes mellitus, two major ageing-related morbidities. Here, we review data on mouse strains with alterations in the GH/IGF-1 axis and their effects on lifespan. The outcome of corresponding or similar mutations in humans is described, as well as the potential mechanisms underlying increased longevity and the therapeutic benefits and risks of medical disruption of the GH/IGF-1 axis in humans.
Collapse
Affiliation(s)
- Riia K Junnila
- Edison Biotechnology Institute, Ohio University, 1 Water Tower Drive, The Ridges (R. K. Junnila, E. O. List, D. E. Berryman, J. J. Kopchick), Department of Radiology, O'Bleness Hospital, 55 Hospital Drive, (J. W. Murrey), Athens, OH 45701, USA
| | - Edward O List
- Edison Biotechnology Institute, Ohio University, 1 Water Tower Drive, The Ridges (R. K. Junnila, E. O. List, D. E. Berryman, J. J. Kopchick), Department of Radiology, O'Bleness Hospital, 55 Hospital Drive, (J. W. Murrey), Athens, OH 45701, USA
| | - Darlene E Berryman
- Edison Biotechnology Institute, Ohio University, 1 Water Tower Drive, The Ridges (R. K. Junnila, E. O. List, D. E. Berryman, J. J. Kopchick), Department of Radiology, O'Bleness Hospital, 55 Hospital Drive, (J. W. Murrey), Athens, OH 45701, USA
| | - John W Murrey
- Edison Biotechnology Institute, Ohio University, 1 Water Tower Drive, The Ridges (R. K. Junnila, E. O. List, D. E. Berryman, J. J. Kopchick), Department of Radiology, O'Bleness Hospital, 55 Hospital Drive, (J. W. Murrey), Athens, OH 45701, USA
| | - John J Kopchick
- Edison Biotechnology Institute, Ohio University, 1 Water Tower Drive, The Ridges (R. K. Junnila, E. O. List, D. E. Berryman, J. J. Kopchick), Department of Radiology, O'Bleness Hospital, 55 Hospital Drive, (J. W. Murrey), Athens, OH 45701, USA
| |
Collapse
|
70
|
Clemmons D. Growth hormone in health and disease: Long-term GH therapy--benefits and unanswered questions. Nat Rev Endocrinol 2013; 9:317-8. [PMID: 23529042 DOI: 10.1038/nrendo.2013.68] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
71
|
Rogol AD. Growth hormone in health and disease: Biological markers of tissue-specific effects of GH therapy. Nat Rev Endocrinol 2013; 9:318-20. [PMID: 23609337 DOI: 10.1038/nrendo.2013.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|