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Götherström G, Johannsson G, Svensson J. Effects of 18 months of GH replacement on cardiovascular risk factors and quality of life in GH deficient adults; a randomized controlled trial using a fixed very low and a standard dose of GH. Growth Horm IGF Res 2022; 67:101510. [PMID: 36240610 DOI: 10.1016/j.ghir.2022.101510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 09/11/2022] [Accepted: 09/21/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Little is known of the effects of a fixed very low dose of growth hormone (GH) replacement on cardiovascular risk factors, bone mass, muscle strength and quality of life (QoL) in hypopituitary patients. DESIGN/PATIENTS/METHODS This was an open-label randomized study performed at a single center. Consecutive hypopituitary patients with adult onset GH deficiency (GHD) and BMI ≥ 27 kg/m2 were randomized to receive a very low fixed dose of GH (LG, n = 9) or a standard dose of GH (SG, n = 9). Body composition, glucose and lipid metabolism, bone mineral content (BMC) and density (BMD), muscle strength, and QoL were measured at baseline and after 6, 12 and 18 months. RESULTS The fixed GH dose in LG was 0.1 mg/day. In SG, the mean baseline GH dose of 0.13 mg/day was gradually increased to 0.31 mg/day at study end. Lean body mass (LBM) as measured using DEXA as well as total body water (TBW) and extracellular water (ECW) were increased only in SG (P < 0.01, P < 0.05, and P < 0.01 vs. LG, respectively). There were no between-groups differences in BMD, BMC, insulin sensitivity, lipids, or muscle strength. Finally, although not significant compared with SG, a sustained improvement in QoL was seen in LG according to the QoL-AGHDA questionnaire. CONCLUSION In this pilot study, a fixed very low GH dose improved QoL in GHD adults without any induction of fluid retention. Other effects were comparable to those produced by the standard GH dose. Replacement with a very low GH dose could therefore be a treatment option in hypopituitary patients, especially in patients who do not tolerate higher GH dosage. Trial registration This study is registered at ClinicalTrials.gov, EU-nr 2009-016783-37.
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Affiliation(s)
- Galina Götherström
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg and Region Västra Götaland, Department of Endocrinology, Sahlgrenska University Hospital, SE- 413 45 Göteborg, Sweden.
| | - Gudmundur Johannsson
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg and Region Västra Götaland, Department of Endocrinology, Sahlgrenska University Hospital, SE- 413 45 Göteborg, Sweden
| | - Johan Svensson
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg and Region Västra Götaland, Department of Endocrinology, Sahlgrenska University Hospital, SE- 413 45 Göteborg, Sweden
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Magill L, Laemmer C, Woelfle J, Fimmers R, Gohlke B. Early start of growth hormone is associated with positive effects on auxology and metabolism in Prader-Willi-syndrome. Orphanet J Rare Dis 2020; 15:283. [PMID: 33046090 PMCID: PMC7552493 DOI: 10.1186/s13023-020-01527-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 09/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prader-Willi-Syndrome (PWS) is characterized by hypothalamic-pituitary dysfunction. Recent research suggests starting growth hormone-treatment (GHT) as soon as possible. The aim of this study is to analyze possible differences in auxological parameters, carbohydrate and lipid metabolism between two groups of children with PWS that started GHT either during or after their first year of life. STUDY DESIGN Retrospective longitudinal study of 62 children (31 males) with genetically confirmed PWS. Upon diagnosis all children were offered GHT, some started immediately, others commenced later. Cohort A (n = 21; 11 males) started GHT at 0.3-0.99 yrs. (mean 0.72 yrs) and Cohort B (n = 41; 20 males) commenced GHT at 1.02-2.54 yrs. (mean 1.42 yrs) of age. Fasting morning blood samples and auxological parameters were obtained before the start of therapy and semi-annually thereafter. Differences between the two cohorts were estimated with a linear mixed-effect model. RESULTS Mean length/height-SDSPWS differed significantly between the groups [1 yr: A: 0.37 (±0.83) vs B: 0.05 (±0.56); 5 yrs.: A: 0.81 (±0.67) vs B: 0.54 (±0.64); p = 0.012]. No significant differences were found in BMI, lean body mass or body fat. Low-density cholesterol was significantly lower in A than in B [LDL: 1 yr: A: 79 (±20) mg/dl vs B: 90 (±19) mg/dl; 5 yrs.: A: 91(±18) mg/dl vs 104 (±26) mg/dl; p = 0.024]. We found significant differences in the glucose homeostasis between the groups [fasting insulin: p = 0.012; HOMA-IR: p = 0.006; HbA1c: p < 0.001; blood glucose: p = 0.022]. CONCLUSIONS An early start of GHT during the first year of life seems to have a favorable effect on height-SDS and metabolic parameters.
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Affiliation(s)
- Lucy Magill
- Department of Pediatric Endocrinology and Diabetology, Children's Hospital, University of Bonn, Venusberg-Campus, Building 30, 53127, Bonn, Germany
| | - Constanze Laemmer
- Pediatric Endocrinology and Diabetology, St. Bernward Hospital, Treibestraße 9, 31134, Hildesheim, Germany
| | - Joachim Woelfle
- Children's University Hospital Erlangen, Loschgestrasse 15, 91054, Erlangen, Germany
| | - Rolf Fimmers
- University Hospital of Bonn, Institute for Medical Biometry, University of Bonn, Venusberg-Campus, 53127, Bonn, Germany
| | - Bettina Gohlke
- Department of Pediatric Endocrinology and Diabetology, Children's Hospital, University of Bonn, Venusberg-Campus, Building 30, 53127, Bonn, Germany.
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Kim JH, Chae HW, Chin SO, Ku CR, Park KH, Lim DJ, Kim KJ, Lim JS, Kim G, Choi YM, Ahn SH, Jeon MJ, Hwangbo Y, Lee JH, Kim BK, Choi YJ, Lee KA, Moon SS, Ahn HY, Choi HS, Hong SM, Shin DY, Seo JA, Kim SH, Oh S, Yu SH, Kim BJ, Shin CH, Kim SW, Kim CH, Lee EJ. Diagnosis and Treatment of Growth Hormone Deficiency: A Position Statement from Korean Endocrine Society and Korean Society of Pediatric Endocrinology. Endocrinol Metab (Seoul) 2020; 35:272-287. [PMID: 32615711 PMCID: PMC7386113 DOI: 10.3803/enm.2020.35.2.272] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/23/2020] [Indexed: 12/29/2022] Open
Abstract
Growth hormone (GH) deficiency is caused by congenital or acquired causes and occurs in childhood or adulthood. GH replacement therapy brings benefits to body composition, exercise capacity, skeletal health, cardiovascular outcomes, and quality of life. Before initiating GH replacement, GH deficiency should be confirmed through proper stimulation tests, and in cases with proven genetic causes or structural lesions, repeated GH stimulation testing is not necessary. The dosing regimen of GH replacement therapy should be individualized, with the goal of minimizing side effects and maximizing clinical improvements. The Korean Endocrine Society and the Korean Society of Pediatric Endocrinology have developed a position statement on the diagnosis and treatment of GH deficiency. This position statement is based on a systematic review of evidence and expert opinions.
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Affiliation(s)
- Jung Hee Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
| | - Hyun Wook Chae
- Department of Pediatrics, Yonsei University College of Medicine, Seoul,
Korea
| | - Sang Ouk Chin
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul,
Korea
| | - Cheol Ryong Ku
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul,
Korea
| | - Kyeong Hye Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang,
Korea
| | - Dong Jun Lim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Kwang Joon Kim
- Division of Geriatrics, Department of Internal Medicine, Yonsei University College of Medicine, Seoul,
Korea
| | - Jung Soo Lim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju,
Korea
| | - Gyuri Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Yun Mi Choi
- Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong,
Korea
| | - Seong Hee Ahn
- Department of Endocrinology, Inha University School of Medicine, Incheon,
Korea
| | - Min Ji Jeon
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Yul Hwangbo
- Department of Internal Medicine, National Cancer Center, Goyang,
Korea
| | - Ju Hee Lee
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon,
Korea
| | - Bu Kyung Kim
- Department of Internal Medicine, Kosin University College of Medicine, Busan,
Korea
| | - Yong Jun Choi
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon,
Korea
| | - Kyung Ae Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju,
Korea
| | - Seong-Su Moon
- Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju,
Korea
| | - Hwa Young Ahn
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul,
Korea
| | - Hoon Sung Choi
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon,
Korea
| | - Sang Mo Hong
- Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong,
Korea
| | - Dong Yeob Shin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul,
Korea
| | - Ji A Seo
- Division of Endocrinology, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan,
Korea
| | - Se Hwa Kim
- Department of Internal Medicine, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon,
Korea
| | - Seungjoon Oh
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul,
Korea
| | - Sung Hoon Yu
- Department of Endocrinology and Metabolism, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri,
Korea
| | - Byung Joon Kim
- Division of Endocrinology, Department of Internal Medicine, Gachon University College of Medicine, Incheon,
Korea
| | - Choong Ho Shin
- Department of Pediatrics, Seoul National University College of Medicine, Seoul,
Korea
| | - Sung-Woon Kim
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul,
Korea
| | - Chong Hwa Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Sejong General Hospital, Bucheon,
Korea
| | - Eun Jig Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul,
Korea
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AsghariHanjani N, Vafa M. The role of IGF-1 in obesity, cardiovascular disease, and cancer. Med J Islam Repub Iran 2019; 33:56. [PMID: 31456980 PMCID: PMC6708115 DOI: 10.34171/mjiri.33.56] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Indexed: 12/29/2022] Open
Abstract
Background: Insulin-like growth factor1 (IGF1) is a polypeptide that structurally is similar to human pro-insulin, one of the factors that is altered in obesity and many related diseases, hence a large body of research devoted to evaluate it.
Methods: In this mini-review, we briefly explain the role of IGF1 in different conditions, including obesity, cardiovascular disease, and cancer through the results of review and original articles in both animal and human studies.
Results: The short-term metabolic effect of IGF-1 is insulin-like, and its long-term effect is growth factor-like. IGF1 has different roles in the initiation and progression of different diseases, because in some cases, the anti-apoptotic effect, can help cell survival while in others, it may lead to cancer or increment of adipocytes.
Conclusion: It is highly recommended to consider the different impacts of IGF1 in health and diseases prevention in future studies and interventions
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Affiliation(s)
- Nazanin AsghariHanjani
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Vafa
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.,Pediatric Growth and Development Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
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Insulin-Like Growth Factor (IGF) Binding Protein-2, Independently of IGF-1, Induces GLUT-4 Translocation and Glucose Uptake in 3T3-L1 Adipocytes. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2017; 2017:3035184. [PMID: 29422987 PMCID: PMC5750484 DOI: 10.1155/2017/3035184] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 10/23/2017] [Indexed: 01/08/2023]
Abstract
Insulin-like growth factor binding protein-2 (IGFBP-2) is the predominant IGF binding protein produced during adipogenesis and is known to increase the insulin-stimulated glucose uptake (GU) in myotubes. We investigated the IGFBP-2-induced changes in basal and insulin-stimulated GU in adipocytes and the underlying mechanisms. We further determined the role of insulin and IGF-1 receptors in mediating the IGFBP-2 and the impact of IGFBP-2 on the IGF-1-induced GU. Fully differentiated 3T3-L1 adipocytes were treated with IGFBP-2 in the presence and absence of insulin and IGF-1. Insulin, IGF-1, and IGFBP-2 induced a dose-dependent increase in GU. IGFBP-2 increased the insulin-induced GU after long-term incubation. The IGFBP-2-induced impact on GU was neither affected by insulin or IGF-1 receptor blockage nor by insulin receptor knockdown. IGFBP-2 significantly increased the phosphorylation of PI3K, Akt, AMPK, TBC1D1, and PKCζ/λ and induced GLUT-4 translocation. Moreover, inhibition of PI3K and AMPK significantly reduced IGFBP-2-stimulated GU. In conclusion, IGFBP-2 stimulates GU in 3T3-L1 adipocytes through activation of PI3K/Akt, AMPK/TBC1D1, and PI3K/PKCζ/λ/GLUT-4 signaling. The stimulatory effect of IGFBP-2 on GU is independent of its binding to IGF-1 and is possibly not mediated through the insulin or IGF-1 receptor. This study highlights the potential role of IGFBP-2 in glucose metabolism.
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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]
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Cardoso DF, Martinelli CE, Campos VC, Gomes ES, Rocha IES, Oliveira CRP, Vicente TAR, Pereira RMC, Pereira FA, Cartaxo CKA, Milani SLS, Oliveira MCP, Melo EV, Oliveira ALP, Aguiar-Oliveira MH. Comparison between the growth response to growth hormone (GH) therapy in children with partial GH insensitivity or mild GH deficiency. ARQUIVOS BRASILEIROS DE ENDOCRINOLOGIA E METABOLOGIA 2014; 58:23-9. [PMID: 24728160 DOI: 10.1590/0004-2730000002793] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 10/16/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVES GH therapy is still controversial, except in severe GH deficiency (SGHD). The objective of this study was to compare the response to growth hormone (GH) therapy in children with partial GH insensitivity (PGHIS) and mild GH deficiency (MGHD) with those with SGHD. SUBJECTS AND METHODS Fifteen PGHIS, 11 MGHD, and 19 SGHD subjects, followed up for more than one year in the Brazilian public care service, were evaluated regarding anthropometric and laboratory data at the beginning of treatment, after one year (1st year) on treatment, and at the last assessment (up to ten years in SGHD, up to four years in MGHD, and up to eight years in PGHIS). RESULTS Initial height standard deviation score (SDS) in SGHD was lower than in MGHD and PGHIS. Although the increase in 1 st year height SDS in comparison to initial height SDS was not different among the groups, height-SDS after the first year of treatment remained lower in SGHD than in MGHD. There was no difference in height-SDS at the last assessment of the children among the three groups. GH therapy, in the entire period of observation, caused a trend towards lower increase in height SDS in PGHIS than SGHD but similar increases were observed in MGHD and SGHD. CONCLUSION GH therapy increases height in PGHIS and produces similar height effects in MGHD and SGHD.
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Affiliation(s)
- Daniela F Cardoso
- Department of Medicine, Universidade Federal de Sergipe, Aracaju, SE, Brazil
| | - Carlos Eduardo Martinelli
- Department of Pediatrics, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Viviane C Campos
- Department of Medicine, Universidade Federal de Sergipe, Aracaju, SE, Brazil
| | - Elenilde S Gomes
- Department of Medicine, Universidade Federal de Sergipe, Aracaju, SE, Brazil
| | - Ivina E S Rocha
- Department of Medicine, Universidade Federal de Sergipe, Aracaju, SE, Brazil
| | - Carla R P Oliveira
- Department of Medicine, Universidade Federal de Sergipe, Aracaju, SE, Brazil
| | - Taisa A R Vicente
- Department of Medicine, Universidade Federal de Sergipe, Aracaju, SE, Brazil
| | - Rossana M C Pereira
- Department of Medicine, Universidade Federal de Sergipe, Aracaju, SE, Brazil
| | - Francisco A Pereira
- Department of Medicine, Universidade Federal de Sergipe, Aracaju, SE, Brazil
| | - Carla K A Cartaxo
- Department of Medicine, Universidade Federal de Sergipe, Aracaju, SE, Brazil
| | - Soraya L S Milani
- Department of Medicine, Universidade Federal de Sergipe, Aracaju, SE, Brazil
| | - Mario C P Oliveira
- Department of Medicine, Universidade Federal de Sergipe, Aracaju, SE, Brazil
| | - Enaldo V Melo
- Department of Medicine, Universidade Federal de Sergipe, Aracaju, SE, Brazil
| | - Andre L P Oliveira
- Department of Medicine, Universidade Federal de Sergipe, Aracaju, SE, Brazil
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Luque RM, Lin Q, Córdoba-Chacón J, Subbaiah PV, Buch T, Waisman A, Vankelecom H, Kineman RD. Metabolic impact of adult-onset, isolated, growth hormone deficiency (AOiGHD) due to destruction of pituitary somatotropes. PLoS One 2011; 6:e15767. [PMID: 21283519 PMCID: PMC3023710 DOI: 10.1371/journal.pone.0015767] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Accepted: 11/26/2010] [Indexed: 01/06/2023] Open
Abstract
Growth hormone (GH) inhibits fat accumulation and promotes protein accretion, therefore the fall in GH observed with weight gain and normal aging may contribute to metabolic dysfunction. To directly test this hypothesis a novel mouse model of adult onset-isolated GH deficiency (AOiGHD) was generated by cross breeding rat GH promoter-driven Cre recombinase mice (Cre) with inducible diphtheria toxin receptor mice (iDTR) and treating adult Cre+/−,iDTR+/− offspring with DT to selectively destroy the somatotrope population of the anterior pituitary gland, leading to a reduction in circulating GH and IGF-I levels. DT-treated Cre−/−,iDTR+/− mice were used as GH-intact controls. AOiGHD improved whole body insulin sensitivity in both low-fat and high-fat fed mice. Consistent with improved insulin sensitivity, indirect calorimetry revealed AOiGHD mice preferentially utilized carbohydrates for energy metabolism, as compared to GH-intact controls. In high-fat, but not low-fat fed AOiGHD mice, fat mass increased, hepatic lipids decreased and glucose clearance and insulin output were impaired. These results suggest the age-related decline in GH helps to preserve systemic insulin sensitivity, and in the context of moderate caloric intake, prevents the deterioration in metabolic function. However, in the context of excess caloric intake, low GH leads to impaired insulin output, and thereby could contribute to the development of diabetes.
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Affiliation(s)
- Raul M. Luque
- Research and Development Division, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois, United States of America
- Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, University of Illinois at Chicago, Chicago, Illinois, United States of America
- Department of Cell Biology, Physiology and Immunology, University of Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), and CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Córdoba, Spain
| | - Qing Lin
- Research and Development Division, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois, United States of America
- Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - José Córdoba-Chacón
- Department of Cell Biology, Physiology and Immunology, University of Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), and CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Córdoba, Spain
| | - Papasani V. Subbaiah
- Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Thorsten Buch
- Neuroimmunology Division, Institute of Experimental Immunology, Department of Pathology, University Hospital Zürich, Zürich, Switzerland
| | - Ari Waisman
- Institute for Molecular Biology, University Medical Centre, University of Mainz, Mainz, Germany
| | - Hugo Vankelecom
- Laboratory of Tissue Plasticity, Department of Molecular Cell Biology, University of Leuven (K.U.Leuven), Leuven, Belgium
| | - Rhonda D. Kineman
- Research and Development Division, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois, United States of America
- Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, University of Illinois at Chicago, Chicago, Illinois, United States of America
- * E-mail:
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Arafat AM, Möhlig M, Weickert MO, Schöfl C, Spranger J, Pfeiffer AFH. Improved insulin sensitivity, preserved beta cell function and improved whole-body glucose metabolism after low-dose growth hormone replacement therapy in adults with severe growth hormone deficiency: a pilot study. Diabetologia 2010; 53:1304-13. [PMID: 20372873 DOI: 10.1007/s00125-010-1738-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2009] [Accepted: 03/02/2010] [Indexed: 10/19/2022]
Abstract
AIMS/HYPOTHESIS Growth hormone-deficient patients show deterioration of insulin sensitivity and beta cell function. High-dose growth hormone treatment often induces further impairment of insulin sensitivity, leading to an increase in insulin and glucose levels or even, in cases of preexisting beta cell defect, to overt diabetes. However, low-dose treatment may improve insulin sensitivity, although data in humans with detailed metabolic phenotyping are as yet not available. We postulated that long-term low-dose growth hormone replacement, restoring IGF-1 to the low-normal range, might beneficially affect glucose metabolism. METHODS We studied prospectively the metabolic responses to 24 and 48 weeks of growth hormone treatment in a small group of six adults with severe growth hormone deficiency (four men, two women; age 40-59 years; BMI 30.2 +/- 1 kg/m(2); mean growth hormone dose 0.3 +/- 0.04 mg/day). All participants underwent an oral glucose tolerance test, euglycaemic-hyperinsulinaemic clamp and hyperglycaemic-hyperinsulinaemic clamp plus i.v. L: -arginine on three occasions. Insulin sensitivity was measured by calculating the M value during the steady state of the euglycaemic-hyperinsulinaemic clamp. Insulin secretion and clearance were estimated from AUC(C-peptide), AUC(insulin) and their ratio at each phase of the hyperglycaemic-hyperinsulinaemic clamp. RESULTS Growth hormone significantly improved insulin sensitivity (M value 13.8 +/- 2.6 [baseline] vs 19.6 +/- 2.6 [24 weeks] and 23.7 +/- 1.9 [48 weeks] micromol kg(-1) min(-1); p < 0.01). Although the insulin response to glucose and arginine decreased slightly, the disposition index, integrating insulin sensitivity and secretion, significantly increased (p < 0.01), indicating an improvement in whole-body glucose metabolism. Insulin clearance was not affected during treatment (p > 0.05). CONCLUSIONS/INTERPRETATION Our data indicate that long-term low-dose growth hormone treatment may improve insulin sensitivity and whole-body glucose metabolism in adults with severe growth hormone-deficiency.
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Affiliation(s)
- A M Arafat
- Department of Endocrinology, Diabetes and Nutrition, Charité-University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany.
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Roemmler J, Kuenkler M, Schneider HJ, Dieterle C, Schopohl J. Comparison of glucose and lipid metabolism and bone mineralization in patients with growth hormone deficiency with and without long-term growth hormone replacement. Metabolism 2010; 59:350-8. [PMID: 19800640 DOI: 10.1016/j.metabol.2009.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2009] [Revised: 08/01/2009] [Accepted: 08/04/2009] [Indexed: 01/29/2023]
Abstract
The effects of long-term growth hormone (GH) substitution in pituitary-insufficient patients with GH deficiency (GHD-pats) on glucose and lipid metabolism and bone mineral density (BMD) have yet to be ascertained. We performed this cross-sectional study comparing GHD-pats with and without long-term GH substitution. We measured lipid parameters at baseline and glucose and insulin concentrations for 3 hours during oral glucose tolerance test in 52 GHD-pats (21 female and 31 male; median age, 51.5 years [27-82]). Twenty-two GHD-pats were on constant GH substitution (GH-Subs) for a median of 10 years (2-42 years). Thirty GHD-pats had not been substituted for at least 2 years (non-Subs). For analyses of beta-cell function, insulin resistance (IR), and sensitivity, homeostatic model assessment (HOMA)-beta , HOMA-IR, and insulin sensitivity index were used, respectively. Body composition and BMD were measured by dual-energy x-ray absorptiometry. Age and body mass index did not differ significantly between groups. Fasting glucose was significantly lower for GH-Subs than non-Subs (87 mg/dL [71-103] vs non-Subs 89 mg/dL [71-113], P < .05), whereas basal insulin did not differ significantly (10 muU/mL (4-42) vs non-Subs 10 microU/mL [4-63]). Glucose and insulin levels at 120 minutes as well as patients' area under the curve, C-peptide, hemoglobin A(1c), waist-hip ratio, HOMA-beta, HOMA-IR, insulin sensitivity index, lipid parameters, and BMD did not differ significantly; but total fat mass was significantly higher in non-Subs (37% [20%-52%] vs GH-sub 31% [13%-54%], P < .01). More non-Subs had abnormal glucose tolerance (19 [63%] vs GH-Subs 9 [41%]). Long-term GH substitution trends to beneficially influence fasting glucose and glucose tolerance, although differences are sparse. Growth hormone substitution alone does not seem to significantly impact on insulin sensitivity, lipid metabolism, and BMD in patients with pituitary insufficiency.
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Affiliation(s)
- Josefine Roemmler
- Department of Internal Medicine (Endocrinology)-Innenstadt, University of Munich, 80336 München, Germany.
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Park MJ, Jung SR, Jung HL, Craig BW, Lee CD, Kang HY. Effects of 4 weeks recombinant human growth hormone administration on insulin resistance of skeletal muscle in rats. Yonsei Med J 2008; 49:1008-16. [PMID: 19108026 PMCID: PMC2628033 DOI: 10.3349/ymj.2008.49.6.1008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Effect of recombinant human growth hormone (rhGH) administration on lipid storage, and its subsequent effect on insulin sensitivity have not yet been adequately examined. Thus, we investigated the effects of rhGH treatment on muscle triglyceride (TG) and ceramide content, and insulin sensitivity after 4 weeks of rhGH administration in rats. MATERIALS AND METHODS Fourteen rats were randomly assigned to two groups: rhGH injection group (GH, n = 7) and saline injection group (CON, n = 7). GH received rhGH by subcutaneous injections (130 microg.kg(-1).day(-1), 6 days.week(-1)) for 4 weeks, while CON received saline injections that were equivalent in volume to GH group. Intramuscular TG and ceramide content and hepatic TG content were measured. To determine insulin sensitivity, oral glucose tolerance test (OGTT) and muscle incubation for glucose transport rate were performed in rats, and used as indicators of insulin sensitivity. We also examined plasma lipid profiles. RESULTS After 4 weeks of rhGH treatment, the GH group had higher muscle and liver TG contents than the CON (p < 0.05). Ceramide content in GH was significantly greater than that in CON (p < 0.05). GH also had higher plasma levels of FFA (p < 0.05), glucose and insulin responses during OGTT (p < 0.05), and lower glucose transport rates in submaximal insulin concentration (p < 0.05) as compared with CON. Results indicate that rhGH treatment is associated with insulin resistance in rats. CONCLUSION rhGH treatment elevated muscle TG and ceramide content, and hepatic TG content. Thus, elevation of these compounded by rhGH treatment could contribute to the development of insulin resistance in rats.
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Affiliation(s)
- Mi Jung Park
- Department of Pediatrics, Sanggye Paik Hospital, Inje University School of Medicine, Seoul, Korea
| | - Su Ryun Jung
- Department of Physical Education, Kyungpook National University, Daegu, Korea
| | - Hyun Lyung Jung
- Department of Physical Education, Kyungpook National University, Daegu, Korea
| | - Bruce W. Craig
- Human Performance Laboratory, Ball State University, Muncie, Indiana, USA
| | - Chong-Do Lee
- Department of Exercise and Wellness, Arizona State University, Mesa, Arizona, USA
| | - Ho Youl Kang
- Department of Physical Education, Kyungpook National University, Daegu, Korea
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Schwartz ET, Holtorf K. Hormones in Wellness and Disease Prevention: Common Practices, Current State of the Evidence, and Questions for the Future. Prim Care 2008; 35:669-705. [DOI: 10.1016/j.pop.2008.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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13
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Gatford KL, Owens JA, Li S, Moss TJM, Newnham JP, Challis JRG, Sloboda DM. Repeated betamethasone treatment of pregnant sheep programs persistent reductions in circulating IGF-I and IGF-binding proteins in progeny. Am J Physiol Endocrinol Metab 2008; 295:E170-8. [PMID: 18492775 PMCID: PMC2493590 DOI: 10.1152/ajpendo.00047.2008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Exposure to synthetic glucocorticoids in utero markedly improves survival after preterm birth, but repeated exposures impair fetal and postnatal growth and are associated with evidence of insulin resistance in later life. The insulin-like growth factor (IGF) axis is an important regulator of growth and metabolism before and after birth. We have therefore investigated the effects of repeated maternal betamethasone injections on plasma IGF-I, IGF-II, and IGF-binding proteins (IGFBP) in fetal and postnatal progeny in the sheep. Pregnant sheep carrying male fetuses were injected with saline or betamethasone at 104, 111, and 118 days of gestation (dG, term approximately 150 dG). Plasma samples were collected postmortem from fetuses before (75, 84, 101 dG) or after one (109 dG), two (116 dG), or three (121-122, 132-133, 145-147 dG) doses of saline or betamethasone and from progeny at 42 and 84 days of age. Fetal weight was reduced after two or more maternal betamethasone injections, and this effect persisted to term. Repeated betamethasone exposures reduced plasma IGF-I and total IGFBP in fetuses at 133 dG and progeny at 84 days, and reduced plasma IGFBP-3 at 84 days. Fetal plasma IGF-II tended to increase transiently at 109 dG following the first betamethasone injection. Fetal, placental, and/or postnatal weights correlated positively with concomitant plasma IGF-I, IGF-II, and total IGFBP. We conclude that repeated exposure to synthetic glucocorticoids in utero programs the IGF axis before and after birth, which may contribute to the adverse effects of betamethasone exposure on growth and metabolism.
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Affiliation(s)
- Kathryn L Gatford
- Research Centre for Early Origins of Adult Disease, Discipline of Obstetrics and Gynaecology, School of Paediatrics and Reproductive Health, University of Adelaide SA 5005, Australia.
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14
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Nedić O, Malenković V, Nikolić JA, Baricević I. Insulin-like growth factor I (IGF-I) as a sensitive biomarker of catabolism in patients with gastrointestinal diseases. J Clin Lab Anal 2007; 21:335-9. [PMID: 17847115 PMCID: PMC6649162 DOI: 10.1002/jcla.20193] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Gastrointestinal ailments evoke changes in the hypothalamic-pituitary-adrenal (HPA) axis and modulation of hepatic protein synthesis. We examined the catabolic effect of certain primary gastrointestinal diseases and surgery on the concentration of insulin-like growth factor I (IGF-I). Blood samples from patients with gastric cancer (GC), cholecystitis (CC), or inguinal hernia (IH) were taken before and after surgery. The concentrations of IGF-I, IGF binding protein-1 (IGFBP-1), insulin, cortisol, and glucose were determined. In GC patients the concentration of IGF-I was reduced and the concentrations of IGFBP-1 and cortisol were elevated preoperatively; after surgery, IGFBP-1 normalized. In CC patients the concentration of IGF-I was low and the concentration of IGFBP-1 was high before cholecystectomy; after surgery IGFBP-1 returned to normal and the concentration of cortisol increased. In IH patients the concentration of IGF-I was low and the concentrations of IGFBP-1 and cortisol were high before surgery; after laparotomy IGFBP-1 returned to normal. The metabolic changes were present in all analyzed patient groups, regardless of the severity of disease and nutrition. The concentration of IGF-I was reduced before surgery and remained reduced after, recommending IGF-I as a metabolic marker in both pre and postoperative examination of patients.
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Affiliation(s)
- Olgica Nedić
- Institute for the Application of Nuclear Energy (INEP), University of Belgrade, Belgrade Serbia.
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15
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Rodriguez S, Gaunt TR, Day INM. Molecular genetics of human growth hormone, insulin-like growth factors and their pathways in common disease. Hum Genet 2007; 122:1-21. [PMID: 17534663 DOI: 10.1007/s00439-007-0378-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2006] [Accepted: 05/08/2007] [Indexed: 12/29/2022]
Abstract
The human growth hormone gene (GH1) and the insulin-like growth factor 1 and 2 genes (IGF1 and IGF2) encode the central elements of a key pathway influencing growth in humans. This "growth pathway" also includes transcription factors, agonists, antagonists, receptors, binding proteins, and endocrine factors that constitute an intrincate network of feedback loops. GH1 is evolutionarily coupled with other genes in linkage disequilibrium in 17q24.2, and the same applies to IGF2 in 11p15.5. In contrast, IGF1 in 12q22-24.1 is not in strong linkage disequilibrium with neighbouring genes. Knowledge of the functional architecture of these regions is important for the understanding of the combined evolution and function of GH1, IGF2 and IGF1 in relation to complex diseases. A number of mutations accounting for rare Mendelian disorders have been described in GH-IGF elements. The constellation of genes in this key pathway contains potential candidates in a number of complex diseases, including growth disorders, metabolic syndrome, diabetes (notably IGF2BP2) cardiovascular disease, and central nervous system diseases, and in longevity, aging and cancer. We review these genes and their associations with disease phenotypes, with special attention to metabolic risk traits.
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Affiliation(s)
- Santiago Rodriguez
- Bristol Genetic Epidemiology Laboratories and MRC Centre for Causal Analyses in Translational Epidemiology (CAiTE), Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol, BS8 2PR, UK.
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