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Rosenberg AGW, Passone CGB, Pellikaan K, Damiani D, van der Lely AJ, Polak M, Bernardo WM, de Graaff LCG. Growth Hormone Treatment for Adults With Prader-Willi Syndrome: A Meta-Analysis. J Clin Endocrinol Metab 2021; 106:3068-3091. [PMID: 34105729 PMCID: PMC8475230 DOI: 10.1210/clinem/dgab406] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Features of Prader-Willi syndrome (PWS) overlap with features of growth hormone (GH) deficiency, like small hands and feet, short stature, increased body fat, and low muscle mass and strength. In children with PWS, GH treatment (GHt) improves physical health and cognition. GHt has become the standard of care in PWS children, but in adults this is not yet the case. OBJECTIVE This work aims to provide an overview of the current knowledge on GHt in PWS adults. METHODS Medline, Embase, and the Cochrane Central Register of Controlled Trials databases were searched. Study selection included randomized clinical trials (RCTs) and nonrandomized (un)controlled trials (NRCTs) that reported data for adults with PWS, who received GHt for at least 6 months. Data on body composition, body mass index (BMI), cardiovascular end points, bone, cognitive function, quality of life, and safety were extracted. RESULTS Nine RCTs and 20 NRCTs were included. Body composition improved during 12 months of GHt with an increase in mean (95% CI) lean body mass of 1.95 kg (0.04 to 3.87 kg) and a reduction of mean (95% CI) fat mass of -2.23% (-4.10% to -0.36%). BMI, low-density lipoprotein cholesterol levels, fasting glucose levels, and bone mineral density did not change during GHt. There were no major safety issues. CONCLUSION GHt appears to be safe and improves body composition in adults with PWS. Because poor body composition is closely linked to the observed high incidence of cardiovascular morbidity in adults with PWS, improving body composition might reduce cardiovascular complications in this vulnerable patient group.
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Affiliation(s)
- Anna G W Rosenberg
- Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Centre Rotterdam, 3015 GD Rotterdam, the Netherlands
- Dutch Centre of Reference for Prader-Willi syndrome, the Netherlands
| | - Caroline G B Passone
- Pediatric Endocrinology Unit, Universidade de São Paulo, São Paulo, Brazil
- Pediatric Endocrinology, Gynecology and Diabetology, Centre de Référence des Pathologies Gynécologiques Rares et des Maladies Endocriniennes Rares de la Croissance et du Développement, Hôpital Universitaire Necker Enfants Malades, Université de Paris, 75015 Paris, France
| | - Karlijn Pellikaan
- Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Centre Rotterdam, 3015 GD Rotterdam, the Netherlands
- Dutch Centre of Reference for Prader-Willi syndrome, the Netherlands
| | - Durval Damiani
- Pediatric Endocrinology Unit, Universidade de São Paulo, São Paulo, Brazil
| | - Aart J van der Lely
- Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Centre Rotterdam, 3015 GD Rotterdam, the Netherlands
| | - Michel Polak
- Pediatric Endocrinology, Gynecology and Diabetology, Centre de Référence des Pathologies Gynécologiques Rares et des Maladies Endocriniennes Rares de la Croissance et du Développement, Hôpital Universitaire Necker Enfants Malades, Université de Paris, 75015 Paris, France
| | | | - Laura C G de Graaff
- Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Centre Rotterdam, 3015 GD Rotterdam, the Netherlands
- Dutch Centre of Reference for Prader-Willi syndrome, the Netherlands
- Academic Centre for Growth, Erasmus MC, University Medical Centre Rotterdam, 3015 GD Rotterdam, the Netherlands
- Correspondence: Laura C. G. de Graaff, MD, PhD, Department of Internal Medicine-Endocrinology, Erasmus University Medical Centre, Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands.
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Frixou M, Vlek D, Lucas-Herald AK, Keir L, Kyriakou A, Shaikh MG. The use of growth hormone therapy in adults with Prader-Willi syndrome: A systematic review. Clin Endocrinol (Oxf) 2021; 94:645-655. [PMID: 33296095 DOI: 10.1111/cen.14372] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/16/2020] [Accepted: 11/16/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Despite clear benefits in the management of children with Prader-Willi syndrome (PWS), the role of growth hormone (GH) in adults is unclear. The aim of this study was to conduct a systematic review to evaluate the effects of GH on body composition, bone health and cardiovascular health in adults with PWS. DESIGN A systematic computerized literature search of the PubMed database was conducted by two independent reviewers. Inclusion criteria were individuals over the age of 16 years with a genetic diagnosis of PWS who had received GH therapy, together with assessment of body composition, bone health or cardiovascular health. RESULTS Twenty full-text papers met the inclusion criteria, encompassing 364 unique patients. No differences in body mass index (BMI) were noted, although 2 studies reported increased BMI after GH cessation. Data demonstrated statistically significant increases in lean body mass and reductions in percentage fat mass. Studies reported inconsistent effects of GH on cholesterol and echocardiography parameters. No studies reported differences in bone mineral density, although one reported improved bone geometry. Minor adverse events including pretibial oedema, headache and transient impaired glucose tolerance were reported in 7 studies. CONCLUSIONS These data suggest that GH is safe and well tolerated in adults with PWS, with evidence of improvement in body composition. Further longitudinal studies are still required to investigate the effects of GH on bone and cardiovascular health. Where GH is used in adults with PWS, this should be managed by a specialist multidisciplinary team with regular monitoring initiated.
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Affiliation(s)
- Mikaela Frixou
- Developmental Endocrinology Research Group, Royal Hospital for Children, University of Glasgow, Glasgow, UK
| | - Diane Vlek
- Developmental Endocrinology Research Group, Royal Hospital for Children, University of Glasgow, Glasgow, UK
| | - Angela K Lucas-Herald
- Developmental Endocrinology Research Group, Royal Hospital for Children, University of Glasgow, Glasgow, UK
| | - Lindsay Keir
- Developmental Endocrinology Research Group, Royal Hospital for Children, University of Glasgow, Glasgow, UK
| | - Andreas Kyriakou
- Developmental Endocrinology Research Group, Royal Hospital for Children, University of Glasgow, Glasgow, UK
| | - M Guftar Shaikh
- Developmental Endocrinology Research Group, Royal Hospital for Children, University of Glasgow, Glasgow, UK
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3
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Yang X. Growth hormone treatment for Prader-Willi syndrome: A review. Neuropeptides 2020; 83:102084. [PMID: 32859387 DOI: 10.1016/j.npep.2020.102084] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 07/21/2020] [Accepted: 08/18/2020] [Indexed: 12/30/2022]
Abstract
The Prader-Willi Syndrome (PWS) is a rare developmental disorder that contributed by multiple genes. Phenotypically, infants with PWS exhibit hypotonia and developmental delay, whilst older children and adults have cognitive impairments, neuropsychiatric symptoms, impaired motor development, neurological anomalies, endocrine dysfunctions like growth hormone (GH) deficiency, and hyperphagia that leads to obesity. Although mechanisms remain elusive, GH treatment has been recommended as the standard treatment for PWS children. In addition to better motor development, improved body composition and linear growth have been well established, but mental flexibility and behavioural problems remained largely untouched. This review will systemically analyze the recent clinical trials of GH treatment on PWS patients. The emphasis is on the mental and behavioural improvements by GH treatment, and a few concerns to initiate GH treatment. This review will finally propose possible future explorations on basic studies that may shed new light on clinical trials of GH treatment on PWS.
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Affiliation(s)
- Xin Yang
- Gritscience Biopharmaceuticals Co., Ltd, Life Science Park Road, Changping District, Beijing, China.
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4
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Damen L, Grootjen LN, Donze SH, Juriaans AF, de Graaff LCG, van der Velden JAEM, Hokken-Koelega ACS. Three years of growth hormone treatment in young adults with Prader-Willi Syndrome previously treated with growth hormone in childhood: Effects on glucose homeostasis and metabolic syndrome. Clin Endocrinol (Oxf) 2020; 93:439-448. [PMID: 32609902 DOI: 10.1111/cen.14274] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 11/29/2022]
Abstract
CONTEXT Growth hormone (GH) has been approved for children with Prader-Willi syndrome (PWS) and significantly improves body composition in adults with PWS. Adults with PWS are predisposed to develop impaired glucose tolerance (IGT) and diabetes mellitus type 2 (DMT2). Continuation of GH maintains body composition, but GH is known to induce insulin resistance, which might affect glucose homeostasis. Studies on long-term effects of GH treatment in adults are very limited. OBJECTIVE To investigate effects of 3 years of GH treatment on glucose homeostasis and prevalence of metabolic syndrome (MS) in adults with PWS. DESIGN Open-label, prospective study. PATIENTS 43 young adults with PWS. SETTING Dutch PWS Reference Center. MAIN OUTCOME MEASURES Glucose and insulin during oral glucose tolerance test. RESULTS Estimated mean (95% CI) fasting glucose and insulin levels remained stable during 3 years of GH treatment. Glucose being 4.6 (4.4-4.8) mmol/l at start and 4.7 (4.6-4.9) mmol/l after 3 years (P = .07); insulin being 59.5 (45.2-75.8) pmol/l and 56.7 (45.2-69.6) pmol/l resp. (P = .72). Sex, ethnicity and fat mass percentage were significantly associated with fasting glucose levels, while IGF-I or GH-dose were not. Blood pressure, lipids and prevalence of MS remained stable during 3 years of GH. IGT prevalence was variable over time, six patients had IGT at start and eleven after 3 years of GH. One patient developed DMT2. However, prevalence of IGT or DMT2 was not significantly higher after 3 years than at study start. CONCLUSIONS Three years of GH treatment in adults with PWS does not impair glucose homeostasis and does not lead to an increased prevalence of DMT2.
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Affiliation(s)
- Layla Damen
- Dutch Growth Research Foundation, Rotterdam, The Netherlands
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands
- Academic Center for Rare Growth Disorders, Erasmus University Medical Center, Rotterdam, the Netherlands
- Dutch Reference Center for Prader-Willi Syndrome, The Netherlands
| | - Lionne N Grootjen
- Dutch Growth Research Foundation, Rotterdam, The Netherlands
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands
- Academic Center for Rare Growth Disorders, Erasmus University Medical Center, Rotterdam, the Netherlands
- Dutch Reference Center for Prader-Willi Syndrome, The Netherlands
| | - Stephany H Donze
- Dutch Growth Research Foundation, Rotterdam, The Netherlands
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands
- Academic Center for Rare Growth Disorders, Erasmus University Medical Center, Rotterdam, the Netherlands
- Dutch Reference Center for Prader-Willi Syndrome, The Netherlands
| | - Alicia F Juriaans
- Dutch Growth Research Foundation, Rotterdam, The Netherlands
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands
- Academic Center for Rare Growth Disorders, Erasmus University Medical Center, Rotterdam, the Netherlands
- Dutch Reference Center for Prader-Willi Syndrome, The Netherlands
| | - Laura C G de Graaff
- Academic Center for Rare Growth Disorders, Erasmus University Medical Center, Rotterdam, the Netherlands
- Dutch Reference Center for Prader-Willi Syndrome, The Netherlands
- Internal medicine, Division of Endocrinology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Janielle A E M van der Velden
- Dutch Reference Center for Prader-Willi Syndrome, The Netherlands
- Department of Pediatrics, Subdivision of Endocrinology, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Anita C S Hokken-Koelega
- Dutch Growth Research Foundation, Rotterdam, The Netherlands
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands
- Academic Center for Rare Growth Disorders, Erasmus University Medical Center, Rotterdam, the Netherlands
- Dutch Reference Center for Prader-Willi Syndrome, The Netherlands
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Abstract
PURPOSE OF REVIEW This review summarizes our current knowledge on type 2 diabetes mellitus (T2DM) and glucose metabolism alterations in Prader-Willi syndrome (PWS), the most common syndromic cause of obesity, and serves as a guide for future research and current best practice. RECENT FINDINGS Diabetes occurs in 10-25% of PWS patients, usually in adulthood. Severe obesity is a significant risk factor for developing of T2DM in PWS. Paradoxically, despite severe obesity, a relative hypoinsulinemia, without the expected insulin resistance, is frequently observed in PWS. The majority of PWS subjects with T2DM are asymptomatic and diabetes-related complications are infrequent. Long-term growth hormone therapy does not adversely influence glucose homeostasis in all ages, if weight gain does not occur. Early intervention to prevent obesity and the regular monitoring of glucose levels are recommended in PWS subjects. However, further studies are required to better understand the physiopathological mechanisms of T2DM in these patients.
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Affiliation(s)
- Antonino Crinò
- Reference Center for Prader-Willi Syndrome, Bambino Gesù Hospital, Research Institute, Via Torre di Palidoro, 00050 Palidoro, Rome, Italy.
| | - Graziano Grugni
- Division of Auxology, S. Giuseppe Hospital, Research Institute, Italian Auxological Institute, Verbania, Italy
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Moix Gil E, Giménez-Palop O, Caixàs A. Treatment with growth hormone in the prader-willi syndrome. ACTA ACUST UNITED AC 2018; 65:229-236. [PMID: 29510967 DOI: 10.1016/j.endinu.2018.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 01/07/2018] [Accepted: 01/10/2018] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The Prader-Willi syndrome (PWS) is a rare genetic disorder caused by absence of expression of the paternal alleles in región 15q11.2-q13. Obesity and hormonal deficiencies, especially of growth hormone (GH), are the most important signs from the therapeutic viewpoint. Recombinant GH (rGH) is effective in children and represents the mainstay in treatment; by contrast, little evidence in available in adult patients. OBJECTIVE To review the reported evidence on the beneficial and adverse effects of treatment with rGH in children and adults. DESIGN A review was made of 62 original articles published between 2000 and 2017 using the PubMed database. RESULTS In pediatric and adult PWS, rGH improves body morphology and composition, physical performance, cognition, psychomotor development, respiratory function, and quality of life with few adverse effects. CONCLUSIONS Treatment with rGH is effective and safe and improves quality of life in both children and adults with PWS.
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Affiliation(s)
- Eugènia Moix Gil
- Facultad de Medicina, Unidad Docente Parc Taulí, Universitat Autònoma de Barcelona, Barcelona, España
| | - Olga Giménez-Palop
- Servicio de Endocrinología y Nutrición, Hospital Universitari Parc Tauli, , Sabadell, España
| | - Assumpta Caixàs
- Servicio de Endocrinología y Nutrición, Hospital Universitari Parc Tauli, , Sabadell, España.
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8
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Abstract
Prader-Willi syndrome (PWS) is a complex genetic disorder with implications on the endocrine and neurologic systems, metabolism, and behavior. Early in life, PWS is characterized by hypotonia and failure to thrive, followed by obesity and hyperphagia. Patients with PWS develop hypothalamic dysfunction which may lead growth hormone deficiency (GHD), hypogonadism, hypothyroidism, adrenal insufficiency, and poor bone mineral density (BMD). In addition to hypothalamic dysfunction, individuals with PWS have increased risk for obesity which may be complicated by metabolic syndrome and type 2 diabetes mellitus (T2DM). In this paper, we will review the current literature pertaining to the endocrine concerns of PWS and current recommendations for screening and management of these conditions.
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Affiliation(s)
- Ryan Heksch
- Department of Endocrinology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Manmohan Kamboj
- Department of Endocrinology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Kathryn Anglin
- Department of Endocrinology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Kathryn Obrynba
- Department of Endocrinology, Nationwide Children's Hospital, Columbus, OH, USA
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9
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Abstract
Prader-Willi syndrome (PWS) results from under-expression of the paternally-derived chromosomal region 15q11-13. Growth failure is a recognized feature of PWS, and both quantitative and qualitative defects of the GH/IGF-I axis revealing GH deficiency (GHD) have been demonstrated in most children with PWS. In PWS adults, criteria for GHD are biochemically fulfilled in 8-38% of the studied cohorts. Published data support benefits of early institution of GH therapy (GHT) in PWS children, with positive effects on statural growth, body composition, metabolic homeostasis, and neurocognitive function. Like in pediatric PWS, GHT also yields beneficial effects on lean and body fat, exercise capacity, and quality of life of PWS adults. Although GHT has been generally administered safely in PWS children and adults, careful surveillance of risks is mandatory during prolonged GH replacement for all PWS individuals.
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Affiliation(s)
- Graziano Grugni
- Division of Auxology, I.R.C.C.S. Istituto Auxologico Italiano, Ospedale S. Giuseppe, Verbania, 28921, Italy.
| | - Paolo Marzullo
- Division of General Medicine, I.R.C.C.S. Istituto Auxologico Italiano, Ospedale S. Giuseppe, Verbania, 28921, Italy; Department of Translational Medicine, Università del Piemonte Orientale, Novara, 28100, Italy
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10
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Fintini D, Grugni G, Bocchini S, Brufani C, Di Candia S, Corrias A, Delvecchio M, Salvatoni A, Ragusa L, Greggio N, Franzese A, Scarano E, Trifirò G, Mazzanti L, Chiumello G, Cappa M, Crinò A. Disorders of glucose metabolism in Prader-Willi syndrome: Results of a multicenter Italian cohort study. Nutr Metab Cardiovasc Dis 2016; 26:842-847. [PMID: 27381990 DOI: 10.1016/j.numecd.2016.05.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 05/17/2016] [Accepted: 05/23/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND AIMS Prader-Willi syndrome (PWS) is characterized by a high incidence of altered glucose metabolism (AGM). However, epidemiological data on impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and type 2 diabetes mellitus (T2DM) are still discordant. METHODS AND RESULTS We performed a multicenter study based on 274 PWS patients [144 females, aged 20.3 ± 10.4 yrs (range: 8.1-50.1 years)] evaluating the prevalence for AGM in the entire group, and according to age (children <10 yrs; adolescents 10-18 yrs, and adults >18 yrs), Body Mass Index (BMI = kg/m(2)), gender, genotypes (deletion or uniparental disomy for chromosome 15), and GH therapy (GHT) (untreated, previously or currently treated). Altogether, AGM was detected in 67 (24.4%) of patients (0.7% IFG, 10.2% IGT, 13.5% T2DM). The prevalence of AGM was correlated to age (p = 0.001), BMI (p = 0.001) and HOMA-IR (p = 0.001). However, gender, genotype, and GHT did not influence AGM development in univariate analysis. These data were confirmed as positive predictors when inserted in a multivariate analysis model. CONCLUSION This study is the first report on the prevalence of AGM in a large population of PWS. Overall, PWS subjects show a high prevalence of AGM that appears more common in obese and adult subjects. Our data confirm the main role of obesity on the individual metabolic risk clustering in PWS, and thus reinforce the concept that improvement in weight control remains the most important goal of any PWS treatment program.
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Affiliation(s)
- D Fintini
- Autoimmune Endocrine Diseases Unit, Bambino Gesù Children's Hospital, Research Institute, Rome, Italy.
| | - G Grugni
- Division of Auxology, Italian Auxological Institute, Research Institute, Piancavallo, Verbania, Italy
| | - S Bocchini
- Autoimmune Endocrine Diseases Unit, Bambino Gesù Children's Hospital, Research Institute, Rome, Italy
| | - C Brufani
- Autoimmune Endocrine Diseases Unit, Bambino Gesù Children's Hospital, Research Institute, Rome, Italy
| | - S Di Candia
- Pediatric Department, S. Raffaele Hospital, Milan, Italy
| | - A Corrias
- Pediatric Endocrinology, Regina Margherita Hospital, Turin, Italy
| | - M Delvecchio
- Department of Pediatric Science and Surgery, Pediatric Hospital Giovanni XXIII, Bari, Italy
| | - A Salvatoni
- Pediatric Unit, Insubria University, Varese, Italy
| | - L Ragusa
- Pediatric Unit, Oasi Maria SS, Research Institute, Troina, Enna, Italy
| | - N Greggio
- Pediatric Department, University of Padua, Italy
| | - A Franzese
- Department of Translational Sciences, University Federico II, Naples, Italy
| | - E Scarano
- Pediatric Endocrinology and Rare Diseases Unit, University of Bologna, Italy
| | - G Trifirò
- Pediatric Unit, Salvini Hospital, Rho, Milan, Italy
| | - L Mazzanti
- Pediatric Endocrinology and Rare Diseases Unit, University of Bologna, Italy
| | - G Chiumello
- Pediatric Department, S. Raffaele Hospital, Milan, Italy
| | - M Cappa
- Endocrinology and Diabetology Unit, Bambino Gesù Children's Hospital, Research Institute, Rome, Italy
| | - A Crinò
- Autoimmune Endocrine Diseases Unit, Bambino Gesù Children's Hospital, Research Institute, Rome, Italy.
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11
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Olarescu NC, Heck A, Godang K, Ueland T, Bollerslev J. The Metabolic Risk in Patients Newly Diagnosed with Acromegaly Is Related to Fat Distribution and Circulating Adipokines and Improves after Treatment. Neuroendocrinology 2016; 103:197-206. [PMID: 25592241 DOI: 10.1159/000371818] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 12/31/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Adipose tissue (AT) distribution is closely related to metabolic disease risk. Growth hormone (GH) reduces visceral and total body fat mass and induces whole-body insulin resistance. Our aim was to assess the effects of total and visceral AT (VAT) distribution and derived adipokines on systemic insulin resistance and lipid metabolism in acromegaly. METHODS Seventy adult patients with active acromegaly (43 males, age 49 ± 14 years) were evaluated before treatment, and a subset (n = 30, 20 males) was evaluated after treatment for acromegaly. Body composition and VAT, glucose metabolism parameters, lipids, C-reactive protein, and selected adipokines (vaspin, omentin, adiponectin, and leptin) were measured. RESULTS At baseline, VAT was positively associated with glucose metabolism parameters and with lipids. GH, but not IGF-I, was negatively associated with all AT depots (visceral, trunk, limbs, and total; 0.41 ≤ r ≤ 0.61, p < 0.001 for all) and positively associated with vaspin (r = 0.31, p = 0.013). The fat deposition after treatment was predominantly located on trunk and visceral depots. The lipid profile partially improved, with increases in HDL and apolipoprotein A-I and a decrease in lipoprotein(a). Vaspin decreased and omentin increased. Adiponectin and leptin did not change significantly. The improvement in homeostasis model assessment for insulin resistance (HOMA-IR) was best predicted by the decreases in IGF-I and vaspin and the lack of an increase in trunk fat (R2 = 0.59, p = 0.001). CONCLUSIONS (1) VAT is a metabolic risk factor for patients with active acromegaly; (2) vaspin and omentin levels are influenced by the disease activity but are not associated with VAT mass; (3) fat deposition after treatment occurs predominantly on the trunk and in visceral depots, and (4) insulin resistance decreases and the lipid profile partially improves with treatment.
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Affiliation(s)
- Nicoleta C Olarescu
- Section of Specialized Endocrinology, Department of Endocrinology, Rikshospitalet, Oslo University Hospital, Oslo, Norway
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12
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Vogt KS, Emerick JE. Growth Hormone Therapy in Adults with Prader-Willi Syndrome. Diseases 2015; 3:56-67. [PMID: 28943608 PMCID: PMC5548233 DOI: 10.3390/diseases3020056] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 04/05/2015] [Accepted: 04/10/2015] [Indexed: 01/16/2023] Open
Abstract
Prader-Willi syndrome (PWS) is characterized by hyperphagia, obesity if food intake is not strictly controlled, abnormal body composition with decreased lean body mass and increased fat mass, decreased basal metabolic rate, short stature, low muscle tone, cognitive disability, and hypogonadism. In addition to improvements in linear growth, the benefits of growth hormone therapy on body composition and motor function in children with PWS are well established. Evidence is now emerging on the benefits of growth hormone therapy in adults with PWS. This review summarizes the current literature on growth hormone status and the use of growth hormone therapy in adults with PWS. The benefits of growth hormone therapy on body composition, muscle strength, exercise capacity, certain measures of sleep-disordered breathing, metabolic parameters, quality of life, and cognition are covered in detail along with potential adverse effects and guidelines for initiating and monitoring therapy.
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Affiliation(s)
- Karen S Vogt
- Division of Endocrinology, Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, 20889, MD, USA.
| | - Jill E Emerick
- Division of Endocrinology, Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, 20889, MD, USA.
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13
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Olarescu NC, Jørgensen AP, Godang K, Jurik AG, Frøslie KF, Bollerslev J. Dual-energy X-ray absorptiometry is a valid method to estimate visceral adipose tissue in adult patients with Prader-Willi syndrome during treatment with growth hormone. J Clin Endocrinol Metab 2014; 99:E1727-31. [PMID: 24955611 DOI: 10.1210/jc.2014-2059] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
CONTEXT Visceral adipose tissue (VAT) is established as a risk factor for type 2 diabetes and cardiovascular disease, but the radiation exposure and cost of computed tomography (CT) measurements limits its daily clinical use. OBJECTIVE The main objective of this study was to compare the degree of agreement between VAT measurements by a new dual-energy X-ray absorptiometry (DXA) application and one of the standard methods, CT, in a population of patients with Prader-Willi syndrome (PWS) before and after GH treatment. Furthermore, we tested whether VAT estimations by these two methods are equivalent in assessing the metabolic risk in this population. DESIGN AND PATIENTS Data from the Norwegian population of a multicenter study in adults with genetically proven PWS were used. Subjects with complete anthropometry, biochemical, and imagistic measurements at all study visits (baseline and after 12 and 24 months of GH treatment) (n = 14, six men) were included. VAT was quantified both using CT scans (GE Lightspeed 16 Pro) of the abdomen at L2-L3 level and a total body DXA scan (GE Healthcare Lunar Prodigy). RESULTS VAT DXA was strongly associated with VAT CT at baseline (r = 0.97) and after 12 (r = 0.90) and 24 months (r = 0.89) of GH treatment (all P < .001). We found moderate to strong positive correlations between VAT by both methods, and blood pressure, weight, body mass index, waist circumference, glucose metabolism, and other fat depots (arms, legs, android, trunk, total body) but no association with age, gender, blood lipids, and IGF-I. Adiponectin was negatively associated with the amount of VAT. At baseline, the highest correlation with homeostasis model assessment of insulin resistance (HOMA-IR) was found for VAT DXA (r = 0.76, P = .001) and VAT CT (r = 0.75, P = .002), respectively. CONCLUSION VAT can be accurately estimated by DXA, in patients with PWS, and might contribute to the assessment of the metabolic risk.
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Affiliation(s)
- Nicoleta Cristina Olarescu
- Section of Specialized Endocrinology (N.C.O., A.P.J., K.G., J.B.), Department of Endocrinology, Oslo University Hospital, Rikshospitalet, Faculty of Medicine (N.C.O., J.B.), and Department of Biostatistics (K.F.F.), Institute of Basic Medical Sciences, University of Oslo, N-0424 Oslo, Norway; and Department of Radiology (A.G.J.), Aarhus University Hospital, DK-8000 C Aarhus, Denmark
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