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Huang J, Siyar S, Sharma R, Herrig I, Wise L, Aidt S, List E, Kopchick JJ, Puri V, Lee KY. Adipocyte Subpopulations Mediate Growth Hormone-induced Lipolysis and Glucose Tolerance in Male Mice. Endocrinology 2023; 164:bqad151. [PMID: 37897489 DOI: 10.1210/endocr/bqad151] [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: 05/30/2023] [Revised: 10/03/2023] [Accepted: 10/09/2023] [Indexed: 10/30/2023]
Abstract
In adipose tissue, growth hormone (GH) stimulates lipolysis, leading to an increase in plasma free fatty acid levels and a reduction in insulin sensitivity. In our previous studies, we have found that GH increases lipolysis by reducing peroxisome proliferator-activated receptor γ (PPARγ) transcription activity, leading to a reduction of tat-specific protein 27 (FSP27, also known as CIDEC) expression. In previous studies, our laboratory uncovered 3 developmentally distinct subpopulations of white adipocytes. In this manuscript, we show that one of the subpopulations, termed type 2 adipocytes, has increased GH-induced signaling and lipolysis compared to other adipocyte subtypes. To assess the physiological role of GH-mediated lipolysis mediated by this adipocyte subpopulation, we specifically expressed human FSP27 (hFSP27) transgene in type 2 adipocytes (type2Ad-hFSP27tg mice). Systemically, male type2Ad-hFSP27tg mice displayed reduced serum glycerol release and nonesterified fatty acids levels after acute GH treatment, and improvement in acute, but not chronic, GH-induced glucose intolerance. Furthermore, we demonstrate that type2Ad-hFSP27tg mice displayed improved hepatic insulin signaling. Taken together, these results indicate that this adipocyte subpopulation is a critical regulator of the GH-mediated lipolytic and metabolic response. Thus, further investigation of adipocyte subpopulations may provide novel treatment strategies to regulate GH-induced glucose intolerance in patients with growth and metabolic disorders.
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Affiliation(s)
- Jun Huang
- Department of Biomedical Sciences, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH 45701, USA
| | - Sohana Siyar
- Department of Biomedical Sciences, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH 45701, USA
| | - Rita Sharma
- Department of Biomedical Sciences, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH 45701, USA
| | - Isabella Herrig
- Department of Biomedical Sciences, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH 45701, USA
| | - Lauren Wise
- Department of Biomedical Sciences, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH 45701, USA
| | - Spencer Aidt
- Department of Biomedical Sciences, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH 45701, USA
| | - Edward List
- Department of Biomedical Sciences, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH 45701, USA
- The Diabetes Institute, Ohio University, Athens, OH 45701, USA
| | - John J Kopchick
- Department of Biomedical Sciences, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH 45701, USA
- The Diabetes Institute, Ohio University, Athens, OH 45701, USA
| | - Vishwajeet Puri
- Department of Biomedical Sciences, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH 45701, USA
- The Diabetes Institute, Ohio University, Athens, OH 45701, USA
| | - Kevin Y Lee
- Department of Biomedical Sciences, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH 45701, USA
- The Diabetes Institute, Ohio University, Athens, OH 45701, USA
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Zhou H, Sun L, Zhang S, Wang Y, Wang G. Effect of long-term growth hormone replacement on glucose metabolism in adults with growth hormone deficiency: a systematic review and meta-analysis. Pituitary 2021; 24:130-142. [PMID: 32888174 DOI: 10.1007/s11102-020-01079-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE This systematic review and meta-analysis was performed to summarize the long-term (more than 6 months) effect of growth hormone (GH) replacement therapy (GHRT) on glucose metabolism among adults growth hormone deficiency (AGHD) patients. METHODS We searched MEDLINE, EMBASE and the Cochrane Library databases from inception till March 2020 for relevant studies evaluating the effect of GHRT on glucose metabolism in AGHD patients. Results were stratified into two periods (6-12 months and more than12 months) according to the length of follow-up. RESULTS Thirty-three studies including 11 randomized controlled trials (RCTs) and 22 prospective open-label studies (POLs) were included in the meta-analysis. The findings of this meta-analysis showed that GH supplementation with a duration of 6-12 months among adults with growth hormone deficiency (GHD) significantly increased fasting plasma glucose (FPG) (SMD 0.37; 95% CI 0.25 to 0.49; I2 = 0%; P < 0.00001), fasting insulin (FI) (SMD 0.2; 95% CI 0.08 to 0.33; I2 = 9%; P = 0.001), glycated hemoglobin (HbA1c) (SMD 0.31; 95% CI 0.17 to 0.46; I2 = 10%; P < 0.0001) and homeostasis model of assessment-insulin resistance (HOMA-IR) (SMD 0.28; 95% CI 0.08 to 0.47; I2 = 13%; P = 0.006). Notably, GH intervention with a duration of more than 12 months showed no significant effect on FI (SMD 0.14; 95% CI - 0.09 to 0.37; I2 = 0%; P = 0.24), HbA1c (SMD - 0.02; 95% CI - 0.3 to 0.26; I2 = 72%; P = 0.89) and HOMA-IR levels (SMD 0.04; 95% CI - 0.24 to 0.31; I2 = 0%; P = 0.80) in adults with GHD. However, FPG levels in AGHD were still significantly increased with more than one year intervention period (SMD 0.41; 95% CI 0.29 to 0.53; I2 = 0%; P < 0.00001). CONCLUSION Overall, the current meta-analysis demonstrated that GHRT with a shorter duration (6-12 months) led to a deterioration in glucose metabolism including FPG, FI, HbA1c and HOMA-IR in AGHD patients. However, the negative effects of GH therapy on these glucose homeostasis parameters were not seen in longer duration of GHRT, except for FPG.
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Affiliation(s)
- He Zhou
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, 130021, China
| | - Lin Sun
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, 130021, China
| | - Siwen Zhang
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, 130021, China
| | - Yingxuan Wang
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, 130021, China
| | - Guixia Wang
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, 130021, China.
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Pellegrin MC, Michelon D, Faleschini E, Germani C, Barbi E, Tornese G. Glucose Metabolism Evaluated by Glycated Hemoglobin and Insulin Sensitivity Indices in Children Treated with Recombinant Human Growth Hormone. J Clin Res Pediatr Endocrinol 2019; 11:350-357. [PMID: 30819016 PMCID: PMC6878334 DOI: 10.4274/jcrpe.galenos.2019.2019.0281] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 02/25/2019] [Indexed: 02/04/2023] Open
Abstract
Objective To evaluate glucose metabolism and insulin sensitivity in children with idiopathic growth hormone (GH) deficiency, treated with recombinant human GH (rhGH), and to identify possible risk factors for the development of glucose abnormalities in this population. Methods We retrospectively collected data from 101 patients (60 males, median age 10.4 years, 77 prepubertal), with confirmed GH deficiency, enrolled before starting rhGH and followed up during the first three years of treatment. Glucose metabolism was evaluated annually by oral glucose tolerance test (OGTT) and glycated hemoglobin A1c (HbA1c). OGTT was used to calculate insulin sensitivity (HOMA-S) and insulin resistance (HOMA-IR), defined as HOMA-IR >3. Results RhGH was effective in improving growth and dosages significantly reduced after the first year of therapy. No patient developed diabetes mellitus. After one year of therapy, a significant increase in HbA1c (p=0.0042) and insulin levels (fasting p<0.0001, 60 min p=0.0018, 120 min p=0.0003) was observed, with a higher prevalence of IR (p<0.05). These indices did not alter further during the follow-up and were not related to GH dose or to family history of diabetes. A significant correlation was found only for IR indices and pubertal status, weight and age (p<0.05). Conclusion In this retrospective study on a large GH deficient pediatric population, conventional use of replacement therapy resulted in an increase in HbA1c and IR after one year of therapy, regardless of rhGH dosage. These alterations did not worsen significantly in the following two years and were not associated with overt diabetes.
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Affiliation(s)
| | - Daria Michelon
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Elena Faleschini
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Claudio Germani
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Egidio Barbi
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
- University of Trieste, Trieste, Italy
| | - Gianluca Tornese
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
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Sydlik C, Weissenbacher C, Roeb J, Pozza SBD, Schmidt H. Evaluation of Changes in Insulin Sensitivity in Prepubertal Small for Gestational Age Children Treated with Growth Hormone. Indian J Endocrinol Metab 2019; 23:14-21. [PMID: 31016147 PMCID: PMC6446669 DOI: 10.4103/ijem.ijem_91_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Although growth hormone (GH) therapy for children born small for gestational age (SGA) has been approved for many years, there are still concerns about increasing their risk for insulin resistance and diabetes mellitus type 2. Monitoring of glucose homeostasis is therefore generally recommended, but there is no consensus on either the methods or consequences. METHODS AND AIMS The aim of our study was to analyze the oral Glucose Tolerance Tests (oGTTs) which were performed yearly from baseline to 4 years of GH therapy in a collective of 93 SGA children, who were prepubertal during the whole follow-up. We looked for correlations with auxological and laboratory data as well as predictive baseline results for glucose homeostasis during further treatment. RESULTS While glucose levels remained constant, insulin secretion increased from baseline to the first year of GH therapy. Insulin sensitivity index (ISI) showed no significant change afterwards; HOMA1, HOMA2, and QUICKI stabilized after the second year. For all indices mean values never reached pathological levels and no cases of diabetes mellitus were induced. Higher gestational age, lower birth length, and older age at start of GH therapy were associated with lower insulin sensitivity. No predictive factors for later insulin resistance could be found. CONCLUSION As expected, in GH-treated prepubertal SGA children insulin resistance was induced, but not to pathological levels. No special risk factors for disturbed glucose homeostasis could be identified. Based on our opinion, performing oGTTs in GH-treated SGA children at baseline and in puberty should remain mandatory, but the current study recommendations regarding further surveillance of glucose homeostasis are questionable.
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Affiliation(s)
- Carmen Sydlik
- Department of Pediatric Endocrinology, Dr. von Haunersches Children's Hospital, Ludwig-Maximilian-University of Munich, Lindwurmstr, Munich, Germany
| | - Claudia Weissenbacher
- Department of Pediatric Endocrinology, Dr. von Haunersches Children's Hospital, Ludwig-Maximilian-University of Munich, Lindwurmstr, Munich, Germany
| | - Julia Roeb
- Department of Pediatric Endocrinology, Dr. von Haunersches Children's Hospital, Ludwig-Maximilian-University of Munich, Lindwurmstr, Munich, Germany
| | - Susanne Bechtold-Dalla Pozza
- Department of Pediatric Endocrinology, Dr. von Haunersches Children's Hospital, Ludwig-Maximilian-University of Munich, Lindwurmstr, Munich, Germany
| | - Heinrich Schmidt
- Department of Pediatric Endocrinology, Dr. von Haunersches Children's Hospital, Ludwig-Maximilian-University of Munich, Lindwurmstr, Munich, Germany
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Ciresi A, Radellini S, Guarnotta V, Mineo MG, Giordano C. The metabolic outcomes of growth hormone treatment in children are gender specific. Endocr Connect 2018; 7:879-887. [PMID: 29925523 PMCID: PMC6063876 DOI: 10.1530/ec-18-0135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 06/20/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate the impact of gender on the clinical and metabolic parameters in prepubertal growth hormone deficiency (GHD) children at diagnosis and during GH treatment (GHT). DESIGN The data of 105 prepubertal children (61 males, 44 females, mean age 6.8 ± 0.7 years) affected by idiopathic GHD were retrospectively evaluated. METHODS Body height, BMI, waist circumference (WC), IGF-I, HbA1c, lipid profile, fasting and after-OGTT glucose and insulin levels, insulin sensitivity and secretion indices were evaluated at baseline and after 24 months of GHT. RESULTS At baseline, no significant difference was found in all clinical, hormonal and metabolic parameters between males and females. After 24 months of GHT, both males and females showed a significant increase in height (both P < 0.001), BMI (both P < 0.001), WC (P < 0.001 and P = 0.004, respectively), IGF-I (both P < 0.001), fasting glucose (P < 0.001 and P = 0.001, respectively), fasting insulin (both P < 0.001) and Homa-IR (both P < 0.001), with a concomitant significant decrease in insulin sensitivity index (ISI) (both P < 0.001) and oral disposition index (DIo) (P = 0.001 and P < 0.001, respectively). At 24 months of GHT, females showed significantly higher BMI (P = 0.027), lower ISI (P < 0.001) and DIo (P < 0.001), in concomitance with a significant greater change from baseline to 24 months of BMI (P = 0.013), WC (P < 0.001), ISI (P = 0.002) and DIo (P = 0.072), although the latter does not reach statistical significance. CONCLUSIONS Twenty-four months of GHT in prepubertal children leads to different metabolic outcomes according to gender, with a greater reduction in insulin sensitivity in females, regardless of auxological and hormonal parameters. Therefore, prepubertal GHD females should probably need a more proper monitoring in clinical practice.
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Affiliation(s)
- Alessandro Ciresi
- Section of EndocrinologyBiomedical Department of Internal and Specialist Medicine (DIBIMIS), University of Palermo, Palermo, Italy
| | - Stefano Radellini
- Section of EndocrinologyBiomedical Department of Internal and Specialist Medicine (DIBIMIS), University of Palermo, Palermo, Italy
| | - Valentina Guarnotta
- Section of EndocrinologyBiomedical Department of Internal and Specialist Medicine (DIBIMIS), University of Palermo, Palermo, Italy
| | - Maria Grazia Mineo
- Section of EndocrinologyBiomedical Department of Internal and Specialist Medicine (DIBIMIS), University of Palermo, Palermo, Italy
| | - Carla Giordano
- Section of EndocrinologyBiomedical Department of Internal and Specialist Medicine (DIBIMIS), University of Palermo, Palermo, Italy
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Capalbo D, Esposito A, Improda N, Wasniewska MG, Di Mase R, De Luca F, Bruzzese D, Salerno M. Glucose homeostasis in GHD children during long-term replacement therapy: a case-control study. Endocrine 2018; 59:643-650. [PMID: 28875423 DOI: 10.1007/s12020-017-1408-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 08/22/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate glucose homeostasis in children with growth hormone (GH) deficiency (GHD) receiving long-term replacement therapy. METHODS We evaluated glucose, insulin, HOmeostasis Model Assessment (HOMA-IR), and HbA1c in 100 GHD children at diagnosis and during 5 years of therapy. One hundred healthy children comparable to patients were evaluated at baseline and after 1 and 5 years. RESULTS No difference was detected at baseline between GHD patients and controls in glucose (79.58 ± 9.96 vs. 77.18 ± 8.20 mg/dl), insulin (4.50 ± 3.24 vs. 4.30 ± 2.60 µU/ml), HbA1c (5.20 ± 0.31 vs. 5.25 ± 0.33%) levels, and HOMA-IR (0.93 ± 0.72 vs. 0.86 ± 0.61). One year of GH was associated with a significant increase in insulin (7.21 ± 4.84, p < 0.001) and HOMA-IR (1.32 ± 0.98, p < 0.001) in GHD children, which became different from controls (p < 0.001 and p = 0.004). These parameters did not change further during the following years of treatment in GHD subjects. In contrast, controls did not show significant changes in insulin (4.40 ± 2.60) and HOMA-IR (0.82 ± 0.60) during the first year; however, at the fifth year of the study a significant increase in insulin (6.50 ± 3.50, p = 0.004) and HOMA-IR (1.29 ± 0.54, p < 0.001) was documented, making these parameters comparable between patients and controls. CONCLUSIONS Our results suggest that growth hormone (GH) treatment is not associated with significant impairment of insulin sensitivity in GHD children. The slight impairment observed in GHD adolescents after long-term GH is comparable to that physiologically occurring in healthy pubertal subjects.
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Affiliation(s)
- Donatella Capalbo
- Department of Pediatrics, University "Federico II" of Naples, Naples, Italy
| | - Andrea Esposito
- Department of Translational Medical Sciences Pediatric Endocrinology Section, University "Federico II" of Naples, Naples, Italy
| | - Nicola Improda
- Department of Pediatrics, University "Federico II" of Naples, Naples, Italy
| | | | - Raffaella Di Mase
- Department of Pediatrics, University "Federico II" of Naples, Naples, Italy
| | - Filippo De Luca
- Department of Pediatric Gynecological, Microbiological and Biomedical Sciences, University of Messina, Messina, Italy
| | - Dario Bruzzese
- Department of Public Health, University "Federico II" of Naples, Naples, Italy
| | - Mariacarolina Salerno
- Department of Translational Medical Sciences Pediatric Endocrinology Section, University "Federico II" of Naples, Naples, Italy.
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Ciresi A, Giordano C. Glucose Metabolism in Children With Growth Hormone Deficiency. Front Endocrinol (Lausanne) 2018; 9:321. [PMID: 29942285 PMCID: PMC6005337 DOI: 10.3389/fendo.2018.00321] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 05/28/2018] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The growth hormone (GH)/insulin-like growth factor 1 (IGF-1) axis has a fundamental impact on glucose metabolism. Therefore, both untreated GH deficiency (GHD) and GH treatment (GHT) may be associated with some metabolic alterations, although the abnormalities of glucose metabolism have been investigated by relatively few studies as main outcomes. AIM The present review summarizes the available data on glucose metabolism in children with GHD, providing an overview of the current state of the art in order to better clarify the real metabolic impact of GHD and GHT. METHODS Among all the existing studies, we evaluated all original studies that fulfilled our criteria for analysis reporting parameters of glucose metabolism as the primary or secondary objective. RESULTS The reported impact of GHD per se on glucose metabolism is quite homogeneous, with the majority of studies reporting no significant difference in metabolic parameters between GHD children and controls. Conversely, GHT proves to be more frequently associated with a subtle form of insulin resistance, while both fasting glucose and HbA1c levels remain almost always within the normal range. CONCLUSION The different methods to study glucose metabolism, the heterogeneity of the populations evaluated, the different doses of GH used together with the variable duration of follow-up may be responsible for discrepancy in the results. Long-term longitudinal studies having glucose homeostasis as their primary outcome are still needed in order better to clarify the real metabolic impact of GHD and GHT in children.
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Kim SH, Park MJ. Effects of growth hormone on glucose metabolism and insulin resistance in human. Ann Pediatr Endocrinol Metab 2017; 22:145-152. [PMID: 29025199 PMCID: PMC5642081 DOI: 10.6065/apem.2017.22.3.145] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 09/11/2017] [Indexed: 01/02/2023] Open
Abstract
Growth hormone (GH) is important for promotion of somatic growth and the regulation of substrate metabolism. Metabolic action of GH occurs in multiple tissues including the liver, muscle, fat and pancreas either directly or indirectly through insulin-like growth factor 1. The diabetogenic action of GH has been well-described in previous in vivo studies. In this paper, we review the metabolic effects of GH on peripheral tissues focusing on glucose metabolism and insulin resistance, and discuss results from human studies on the long-term effects of GH administration on insulin resistance and hyperglycemia.
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Affiliation(s)
| | - Mi-Jung Park
- Address for correspondence: Mi-Jung Park, MD, PhD http://orcid.org/0000-0002-7202-500X Department of Pediatrics, Inje University Sanggye Paik Hospital, 1342 Dongilro, Nowon-gu, Seoul 01767, Korea Tel: +82-2-950-8826 Fax: +82-2-950-1246 E-mail:
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Baronio F, Mazzanti L, Girtler Y, Tamburrino F, Fazzi A, Lupi F, Longhi S, Radetti G. The Influence of Growth Hormone Treatment on Glucose Homeostasis in GrowthHormone-Deficient Children: A Six-Year Follow-Up Study. Horm Res Paediatr 2017; 86:196-200. [PMID: 27595543 DOI: 10.1159/000448841] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 07/29/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Growth hormone (GH) influences glucose homeostasis by negatively affecting insulin sensitivity, leading to a compensatory increase in insulin secretion. It has recently been reported, in animals and humans, that GH might also stimulate insulin secretion by directly affecting the growth and function of pancreatic β-cells. The aim of this work was to longitudinally study the insulin sensitivity (HOMA-S), insulin secretion [insulinogenic index (IGI)] and capacity of β-cells to adapt to changes in insulin sensitivity [oral disposition index (ODI)] in GH-deficient (GHD) children under GH treatment. METHODS We studied 99 GHD (62 male, 37 female; age 8.9 ± 3.5 years) children for a median period of 6 years (range 1.5-16.2). Every year, our patients underwent an oral glucose tolerance test, which was used to calculate the HOMA-S, IGI and ODI. RESULTS Although HOMA-S remained unchanged, an increase in IGI and ODI was observed, becoming significant after 6 years of treatment (1.25 ± 1.28 vs. 2.35 ± 2.38, p < 0.05 and 0.57 ± 0.68 vs. 1.50 ± 1.92, p < 0.01, respectively). CONCLUSION Our results suggest a positive influence of GH treatment on the β-cell secretory capacity in children with GH deficiency. © 2016 S. Karger AG, Basel.
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Affiliation(s)
- Federico Baronio
- Department of Woman, Child and Urologic Diseases, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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Abstract
Growth hormone (GH) has a large number of metabolic effects, involving lipid and glucose homoeostasis, lean and fat mass. Growth hormone deficiency (GHD) is associated with a metabolic profile similar to the Metabolic Syndrome which is characterized by dyslipidemia, insulin resistance, haemostatic alterations, oxidative stress, and chronic inflammation. GH replacement treatment in GHD children improves these cardiovascular risk factors, while cessation of GH is associated with a deterioration of most of these risk factors. However, it is unclear whether the changes of these risk factors are associated with an increased risk of cardiovascular diseases especially after discontinuing GH treatment. GH treatment itself can lead to insulin resistance, which probably also influences the cardiovascular health status. Therefore, longitudinal studies with the primary outcome cardiovascular diseases are needed in GHD children. Furthermore, new approaches such as metabolomic studies might be helpful to understand the relationship between GHD, GH treatment, and cardiovascular diseases.
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Affiliation(s)
- Juliane Rothermel
- Department of Paediatric Endocrinology, Diabetes and Nutrition Medicine, Vestische Hospital for Children and Adolescents Datteln, University of Witten/Herdecke, Germany
| | - Thomas Reinehr
- Department of Paediatric Endocrinology, Diabetes and Nutrition Medicine, Vestische Hospital for Children and Adolescents Datteln, University of Witten/Herdecke, Germany.
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Prodam F, Savastio S, Genoni G, Babu D, Giordano M, Ricotti R, Aimaretti G, Bona G, Bellone S. Effects of growth hormone (GH) therapy withdrawal on glucose metabolism in not confirmed GH deficient adolescents at final height. PLoS One 2014; 9:e87157. [PMID: 24498035 PMCID: PMC3907518 DOI: 10.1371/journal.pone.0087157] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 12/18/2013] [Indexed: 11/18/2022] Open
Abstract
CONTEXT OBJECTIVE Growth hormone deficiency (GHD) is associated with insulin resistance and diabetes, in particular after treatment in children and adults with pre-existing metabolic risk factors. Our aims were. i) to evaluate the effect on glucose metabolism of rhGH treatment and withdrawal in not confirmed GHD adolescents at the achievement of adult height; ii) to investigate the impact of GH receptor gene genomic deletion of exon 3 (d3GHR). DESIGN SETTING We performed a longitudinal study (1 year) in a tertiary care center. METHODS 23 GHD adolescent were followed in the last year of rhGH treatment (T0), 6 (T6) and 12 (T12) months after rhGH withdrawal with fasting and post-OGTT evaluations. 40 healthy adolescents were used as controls. HOMA-IR, HOMA%β, insulinogenic (INS) and disposition (DI) indexes were calculated. GHR genotypes were determined by multiplex PCR. RESULTS In the group as a whole, fasting insulin (p<0.05), HOMA-IR (p<0.05), insulin and glucose levels during OGTT (p<0.01) progressively decreased from T0 to T12 becoming similar to controls. During rhGH, a compensatory insulin secretion with a stable DI was recorded, and, then, HOMAβ and INS decreased at T6 and T12 (p<0.05). By evaluating the GHR genotype, nDel GHD showed a decrease from T0 to T12 in HOMA-IR, HOMAβ, INS (p<0.05) and DI. Del GHD showed a gradual increase in DI (p<0.05) and INS with a stable HOMA-IR and higher HDL-cholesterol (p<0.01). CONCLUSIONS In not confirmed GHD adolescents the fasting deterioration in glucose homeostasis during rhGH is efficaciously coupled with a compensatory insulin secretion and activity at OGTT. The presence of at least one d3GHR allele is associated with lower glucose levels and higher HOMA-β and DI after rhGH withdrawal. Screening for the d3GHR in the pediatric age may help physicians to follow and phenotype GHD patients also by a metabolic point of view.
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Affiliation(s)
- Flavia Prodam
- Division of Pediatrics, Department of Health Sciences, University of “Piemonte Orientale Amedeo Avogadro”, Novara, Italy
- Endocrinology, Department of Clinical and Experimental Medicine, University of Piemonte Orientale, Novara, Italy
- I.C.O.S. (Interdisciplinary Center for Obesity Study), Novara, Italy
- * E-mail:
| | - Silvia Savastio
- Division of Pediatrics, Department of Health Sciences, University of “Piemonte Orientale Amedeo Avogadro”, Novara, Italy
| | - Giulia Genoni
- Division of Pediatrics, Department of Health Sciences, University of “Piemonte Orientale Amedeo Avogadro”, Novara, Italy
| | - Deepak Babu
- Laboratory of Human Genetics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Mara Giordano
- I.C.O.S. (Interdisciplinary Center for Obesity Study), Novara, Italy
- Laboratory of Human Genetics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Roberta Ricotti
- Division of Pediatrics, Department of Health Sciences, University of “Piemonte Orientale Amedeo Avogadro”, Novara, Italy
| | - Gianluca Aimaretti
- Endocrinology, Department of Clinical and Experimental Medicine, University of Piemonte Orientale, Novara, Italy
| | - Gianni Bona
- Division of Pediatrics, Department of Health Sciences, University of “Piemonte Orientale Amedeo Avogadro”, Novara, Italy
- I.C.O.S. (Interdisciplinary Center for Obesity Study), Novara, Italy
| | - Simonetta Bellone
- Division of Pediatrics, Department of Health Sciences, University of “Piemonte Orientale Amedeo Avogadro”, Novara, Italy
- Endocrinology, Department of Clinical and Experimental Medicine, University of Piemonte Orientale, Novara, Italy
- I.C.O.S. (Interdisciplinary Center for Obesity Study), Novara, Italy
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12
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Radetti G, Longhi S, Baiocchi M, Cassar W, Buzi F. Changes in lifestyle improve body composition, thyroid function, and structure in obese children. J Endocrinol Invest 2012; 35:281-5. [PMID: 21623157 DOI: 10.3275/7763] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Alterations in thyroid function and structure have been reported in obesity. Function reverses to normal after weight loss, but nothing is known about structure. AIM To evaluate the effect of weight loss on thyroid function and structure in obese children. SUBJECTS AND METHODS The study was conducted in 72 overweight and obese children. Measurement of free T(3) (fT(3)), free T4 (fT(4)), TSH, antithyroid- antibodies and a thyroid ultrasound was performed at the beginning (phase 1) and after a period of 1.8±1.0 yr of lifestyle intervention (phase 2). RESULTS Height SD score (SDS), body mass index SDS, total fat mass did not change from phase 1 to phase 2. Percentage of fat free mass decreased significantly (p<0.05). Waist/height ratio decreased (0.6±0.1 vs 0.5±0.1; p<0.05) as well as waist/hip ratio (0.9±0.1 vs 0.8±0.1; p<0.05). In phase 1, TSH was 2.8±1.7 mU/l; in phase 2, it was 2.2±0.9 mU/l (p<0.05); 17.2% of children showed a TSH level above the normal range (3.6 mU/l) in phase 1, and 6.2% in phase 2 (p<0.05). fT(4) was 10.8±2.2 pg/ml in phase 1 and 10.7±1.9 pg/ml in phase 2. fT(3) was 4.4±1.3 pg/ml (phase 1) and 3.9±1.1 pg/ml (phase 2) (p<0.05). Thyroid volume was -0.5±0.8 SDS (phase 1) and -0.5±1 SDS (phase 2). A non-significant improvement in thyroid structure was observed. CONCLUSIONS In conclusion, healthier lifestyle improves body composition, thyroid function, and structure.
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Affiliation(s)
- G Radetti
- Department of Pediatrics, Regional Hospital of Bolzano, Bolzano, Italy.
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13
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Hoffman RP. Growth hormone (GH) treatment does not restore endothelial function in children with GH deficiency. J Pediatr Endocrinol Metab 2008; 21:323-8. [PMID: 18556963 DOI: 10.1515/jpem.2008.21.4.323] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In adults with growth hormone (GH) deficiency (GHD), GH treatment restores impaired endothelial function, a precursor of cardiovascular disease. Its effect in children with GHD is unknown. METHODS Three months of GH (0.3 mg/kg/wk) were given to nine children with GHD. Endothelial function was measured via reactive hyperemic response. Forearm blood flow (FBF, strain gauge plethysmography) was measured before and after 5 min of upper arm arterial occlusion. Blood pressure and lipid, insulin and glucose levels were measured. Pretreatment endothelial function was compared to 18 previously studied control children. RESULTS Percent fall in forearm vascular resistance was greater in controls (81.2 +/- 1.9%) than in children with GHD (69.6 +/- 5.3%, p = 0.021) but was not affected by GH (60.6 +/- 7.5%). GH markedly increased HOMAIR (21 +/- 7 versus 43 +/- 8, p = 0.004). Plasma lipid levels did not significantly differ. CONCLUSION These results indicate that endothelial function is impaired in children with GHD. GH therapy does not restore the impairment.
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Affiliation(s)
- Robert P Hoffman
- Division of Pediatric Endocrinology, Department of Pediatrics, The Ohio State University College of Medicine Children's Hospital, Columbus, OH 43205, USA.
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14
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Nozue H, Kamoda T, Matsui A. Serum resistin concentrations in growth hormone-deficient children during growth hormone replacement therapy. Metabolism 2007; 56:1514-7. [PMID: 17950102 DOI: 10.1016/j.metabol.2007.06.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2007] [Accepted: 06/05/2007] [Indexed: 11/17/2022]
Abstract
We performed this study to examine whether the serum resistin concentrations in growth hormone (GH)-deficient (GHD) children are influenced by administration of GH and to assess the relationship between serum resistin and free fatty acid levels during GH replacement therapy. The study included 20 prepubertal GHD children (16 boys and 4 girls) who were treated with recombinant human GH (hGH). The serum levels of resistin, insulin-like growth factor I, free fatty acid (FFA), triglyceride, cholesterol and glucose levels, leukocyte counts, and hemoglobin A(1c) were measured at baseline and after 1 month of hGH treatment. The serum resistin levels after hGH therapy were significantly higher than the basal resistin levels (median [range], 6.2 [4.9-11.8] vs 5.6 [4.4-8.3] ng/mL; P < .05), whereas the serum FFA levels were unchanged before and after treatment (0.51 [0.34-0.76] vs 0.37 [0.24-0.60] mEq/L). No significant relationship was found between serum resistin and FFA levels after hGH therapy. Body mass index, serum triglyceride, cholesterol and glucose levels, leukocyte counts, and hemoglobin A(1c) showed no significant differences before and after hGH treatment. Our results suggest that elevated serum resistin levels after 1-month hGH therapy in GHD children are not associated with the GH-induced lipolysis as found in GHD adults during short-time hGH therapy.
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Affiliation(s)
- Hiroki Nozue
- Department of Pediatrics, Tsukuba Medical Center Hospital, Ibaraki 305-8558, Japan.
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15
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Radetti G, Fanolla A, Pappalardo L, Gottardi E. Prematurity may be a risk factor for thyroid dysfunction in childhood. J Clin Endocrinol Metab 2007; 92:155-9. [PMID: 17032720 DOI: 10.1210/jc.2006-1219] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
CONTEXT Children born prematurely and/or small for gestational age (SGA) frequently show disturbances in thyroid function. OBJECTIVE The objective of the study was to determine the role played either by size or gestational age on subsequent thyroid function. DESIGN AND SETTING This cross-sectional study was conducted at a tertiary referral hospital. PATIENTS A total of 117 children, 88 of whom were SGA (mean age 7.8 +/- 2.5 yr) and 29 appropriate for gestational age (AGA) (mean age 8.1 +/- 1.9 yr), were selected for the study. MAIN OUTCOME MEASURES We evaluated TSH, free T(4), free T(3), urinary iodine, and antithyroid antibodies, and all patients underwent a thyroid ultrasound. Insulin sensitivity was assessed with the quantitative insulin sensitivity check index. RESULTS TSH and free T3 were not significantly different in the two groups, whereas free T4 was higher in the AGA group (P < 0.005). Interestingly, four AGA (13.8%) and 17 SGA (19.3%) patients had TSH levels above the upper limit of normality. Thyroid volume was normal and thyroid autoimmunity was excluded. Urinary iodine was also similar in the two groups (115 +/- 66 vs. 143 +/- 87); however, in both groups there were some children [15 AGA (51%) and 13 SGA (14.7%) (P < 0.001)] with a mild to moderate iodine deficiency. By multiple regression analysis, gestational age was found to be the only determinant of TSH serum levels. Insulin sensitivity was the same in both groups of children and similar to controls. CONCLUSIONS Some children born prematurely, independently from their birth size, frequently have disturbances of the hypothalamus-pituitary-thyroid axis later in life.
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Affiliation(s)
- Giorgio Radetti
- Department of Paediatrics, Regional Hospital, via L. Boehler 5, 39100 Bolzano, Italy.
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Salerno M, Esposito V, Farina V, Radetti G, Umbaldo A, Capalbo D, Spinelli L, Muzzica S, Lombardi G, Colao A. Improvement of cardiac performance and cardiovascular risk factors in children with GH deficiency after two years of GH replacement therapy: an observational, open, prospective, case-control study. J Clin Endocrinol Metab 2006; 91:1288-95. [PMID: 16403823 DOI: 10.1210/jc.2005-0981] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
CONTEXT GH deficiency (GHD) in adults is associated with a cluster of cardiovascular risk factors that may contribute to an increased mortality for cardiovascular disease. OBJECTIVE The aim of this study was to evaluate the effect of GHD and GH replacement therapy on cardiac performance, lipid profile, and insulin resistance in children. DESIGN This was a 2-yr case-control prospective study. PATIENTS Thirty children with GHD aged 9.3 +/- 0.5 yr and 30 healthy matched controls were studied. INTERVENTION Children were studied before and after 1 and 2 yr of GH replacement (GHD children) or no treatment (controls). MAIN OUTCOME MEASURES Lipid profile, serum insulin levels, homeostasis model of assessment (HOMA) index, and left ventricular (LV) mass and function by echocardiography were the main outcome measures. RESULTS At study entry, the LV mass index was significantly lower in GHD children (50.2 +/- 1.7) than in controls (60.3 +/- 2.5 g/m(2); P < 0.002), whereas LV systolic and diastolic function, lipid profile, insulin levels, and HOMA index were similar. In GHD children LV mass index significantly increased (66.3 +/- 2.4 g/m(2); P < 0.0001) after 1 yr of GH replacement and remained stable thereafter. LV systolic and diastolic function did not change during treatment. After 2 yr of GH replacement, total cholesterol (P < 0.007) and the atherogenic index (P < 0.0001) significantly decreased, whereas fasting insulin levels (P < 0.001) and HOMA index (P < 0.0001) significantly increased compared with both pretreatment and control values. CONCLUSIONS GHD in children is associated with a reduced cardiac size but with a normal cardiac function, lipid profile, and insulin sensitivity. Two years of GH replacement normalizes cardiac morphology, improves lipid profile, and slightly impairs insulin sensitivity.
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Affiliation(s)
- Mariacarolina Salerno
- Department of Pediatrics, Federico II University of Naples, Via S. Pansini 5, 80131 Naples, Italy.
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