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Kuliczkowska-Płaksej J, Zdrojowy-Wełna A, Jawiarczyk-Przybyłowska A, Gojny Ł, Bolanowski M. Diagnosis and therapeutic approach to bone health in patients with hypopituitarism. Rev Endocr Metab Disord 2024; 25:513-539. [PMID: 38565758 DOI: 10.1007/s11154-024-09878-w] [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] [Accepted: 03/17/2024] [Indexed: 04/04/2024]
Abstract
The results of many studies in recent years indicate a significant impact of pituitary function on bone health. The proper function of the pituitary gland has a significant impact on the growth of the skeleton and the appearance of sexual dimorphism. It is also responsible for achieving peak bone mass, which protects against the development of osteoporosis and fractures later in life. It is also liable for the proper remodeling of the skeleton, which is a physiological mechanism managing the proper mechanical resistance of bones and the possibility of its regeneration after injuries. Pituitary diseases causing hypofunction and deficiency of tropic hormones, and thus deficiency of key hormones of effector organs, have a negative impact on the skeleton, resulting in reduced bone mass and susceptibility to pathological fractures. The early appearance of pituitary dysfunction, i.e. in the pre-pubertal period, is responsible for failure to achieve peak bone mass, and thus the risk of developing osteoporosis in later years. This argues for the need for a thorough assessment of patients with hypopituitarism, not only in terms of metabolic disorders, but also in terms of bone disorders. Early and properly performed treatment may prevent patients from developing the bone complications that are so common in this pathology. The aim of this review is to discuss the physiological, pathophysiological, and clinical insights of bone involvement in pituitary disease.
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Affiliation(s)
- Justyna Kuliczkowska-Płaksej
- Department and Clinic of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, Wybrzeże Pasteura 4, Wrocław, 50-367, Poland
| | - Aleksandra Zdrojowy-Wełna
- Department and Clinic of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, Wybrzeże Pasteura 4, Wrocław, 50-367, Poland
| | - Aleksandra Jawiarczyk-Przybyłowska
- Department and Clinic of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, Wybrzeże Pasteura 4, Wrocław, 50-367, Poland.
| | - Łukasz Gojny
- Department and Clinic of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, Wybrzeże Pasteura 4, Wrocław, 50-367, Poland
| | - Marek Bolanowski
- Department and Clinic of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, Wybrzeże Pasteura 4, Wrocław, 50-367, Poland
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Bioletto F, Sibilla M, Gasco V, Ghigo E, Grottoli S. Excess mortality in patients with non-functioning pituitary adenoma: a systematic review and meta-analysis. J Endocrinol Invest 2024:10.1007/s40618-024-02356-9. [PMID: 38503992 DOI: 10.1007/s40618-024-02356-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 03/03/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Patients with non-functioning pituitary adenoma (NFPA) often present with a variety of clinical manifestations and comorbidities, mainly determined by the local mass effect of the tumor and by hypopituitarism. Whether this has an impact on overall mortality, however, is still unclear. METHODS PubMed/Medline, EMBASE, and Cochrane Library databases were systematically searched until May 2023 for studies reporting data either about standardized mortality ratios (SMRs) or about predictors of mortality in patients with NFPA. Effect sizes were pooled through a random-effect model. This systematic review and meta-analysis was registered in the International Prospective Register of Systematic Reviews (PROSPERO, #CRD42023417782). RESULTS Eleven studies were eligible for inclusion in the systematic review; among these, five studies reported data on SMRs, with a total follow-up time of approximately 130,000 person-years. Patients with NFPA showed an increased mortality risk compared to the general population (SMR = 1.57 [95%CI: 1.20-1.99], p < 0.01). Age and sex appeared to act as effect modifiers, with a trend towards higher SMRs in females (SMR = 1.57 [95%CI: 0.91-2.41], p = 0.10) than in males (SMR = 1.00 [95%CI: 0.89-1.11], p = 0.97), and in patients diagnosed at age 40 years or younger (SMR = 3.19 [95%CI: 2.50-3.97], p < 0.01) compared to those with later onset of the disease (SMR = 1.26 [95%CI: 0.93-1.65], p = 0.13). The trend towards excess mortality was similar in patients with normal (SMR = 1.22 [95%CI: 0.94-1.53], p = 0.13) or deficient (SMR = 1.26 [95%CI: 0.82-1.79], p = 0.27) pituitary function. CONCLUSIONS Excess mortality is observed in patients with NFPA, regardless of pituitary function, especially in women and in patients with a younger age at diagnosis.
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Affiliation(s)
- F Bioletto
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, Turin, 10126, Italy.
| | - M Sibilla
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, Turin, 10126, Italy
| | - V Gasco
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, Turin, 10126, Italy
| | - E Ghigo
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, Turin, 10126, Italy
| | - S Grottoli
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, Turin, 10126, Italy
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van Bunderen CC, Olsson DS. Meta-analysis of mortality in adults with growth hormone deficiency: Does growth hormone replacement therapy really improve mortality rates? Best Pract Res Clin Endocrinol Metab 2023; 37:101835. [PMID: 37914564 DOI: 10.1016/j.beem.2023.101835] [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] [Indexed: 11/03/2023]
Abstract
Growth hormone (GH) deficiency (GHD) is one of the most prevalent deficiencies in patients with hypopituitarism and several cohort studies have demonstrated an increased mortality risk in hypopituitary patients with a presumed GHD. The cause of the excess mortality is most likely multifactorial, including the etiology of the hypopituitarism, non-physiological replacement therapies (mostly glucocorticoid), tumor treatment and its side effects as well as untreated GHD. Several years later, other cohort studies that investigated life expectancy in patients with hypopituitarism on GH replacement therapy (GHRT) that showed a normalized mortality. By comparison of the distribution of characteristics of interest between cohorts, we discuss the existing literature to answer the following question: does growth hormone replacement really improve mortality rates in adult patients with hypopituitarism and GHD? We also conducted a meta-analysis of these studies. Since the literature suffers from selection and time bias (improvement of tumor management and other pituitary hormone replacement therapies), there is no high-quality evidence that replacement therapy for GHD really improves mortality. However, the available data does suggest that GHRT plays a significant part in the normalization of the mortality in patients with hypopituitarism.
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Affiliation(s)
- Christa C van Bunderen
- Division of Endocrinology, Department of Internal Medicine, Radboud University Medical Center, Nijmegen 6525 GA, the Netherlands.
| | - Daniel S Olsson
- Department of Medicine, Sahlgrenska University Hospital, 413 46 Gothenburg, Sweden; Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden; Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden.
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Herodes M, Legaspi A, Garcia JM. Mild traumatic brain injury as a cause of adult growth hormone deficiency: Diagnosis and treatment. Best Pract Res Clin Endocrinol Metab 2023; 37:101818. [PMID: 37666680 DOI: 10.1016/j.beem.2023.101818] [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] [Indexed: 09/06/2023]
Abstract
In recent years, mild traumatic brain injury (mTBI) has been recognized as a cause of acquired growth hormone deficiency (AGHD) and is likely much more prevalent than previous estimates. There is great overlap between persistent symptoms following mTBI and those of AGHD and it is possible that these persistent symptoms of mTBI are, at least in part, due to or aggravated by AGHD. This article reviews the current literature of AGHD following mTBI, and proposes practice recommendations for the screening, diagnosis, and management of patients with AGHD following mTBI.
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Affiliation(s)
- Megan Herodes
- Geriatric Research, Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
| | - Aviel Legaspi
- Geriatric Research, Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.
| | - Jose M Garcia
- Geriatric Research, Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
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Touraine P, Sagna Y, Mattsson AF, Burman P, Van Beek AP, Carlsson MO, Aydin F, Feldt-Rasmussen U, Camacho-Hübner C. Pituitary function and the response to GH therapy in patients with Langerhans cell histiocytosis: analysis of the KIMS database. Eur J Endocrinol 2022; 187:373-381. [PMID: 35830276 PMCID: PMC9346264 DOI: 10.1530/eje-22-0160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 07/04/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To analyze the effectiveness and safety of growth hormone (GH) replacement treatment in adult patients with Langerhans cell histiocytosis (LCH) and GH deficiency (GHD) enrolled in KIMS (Pfizer International Metabolic Database). PATIENTS AND METHODS Patients with LCH and GHD were studied at baseline and some of them after 1 year of GH treatment. The effectiveness of GH is presented as change after 1 year of treatment (mean, 95% CI). The LCH population was compared to two other groups of patients enrolled in KIMS, granulomatous and lymphocytic hypophysitis. RESULTS At baseline, 81 adults with LCH (27 with childhood onset, 56% females), mean age at GHD onset of 29 (15) years were studied. Diabetes insipidus was diagnosed in 86% of patients. Analysis of 1 year of GH treatment was possible in 37 patients. One-year cross-sectional values for the GH dose were 0.39 (s.d.± 0.21) mg and -0.5 (-1.2 to 0.2) for insulin-like growth factor-1 s.d. Total cholesterol decreased 0.9 (-1.5 to -0.3 (mmol/L); P < 0.05); AGHDA-QoL-score (n = 20) was improved by 2.8 points (-5.6 to 0.0; P < 0.05), while mean BMI increased 0.6 ± 3 kg/m2 (95% CI: -0.2 to 1.4). All these effects did not differ from the two other groups after adjusting for age, gender, and baseline values. In 20 of 77 patients included in the safety analysis, 36 serious adverse events were reported during 435 patient-years (82.8/1000); no new safety signals were reported. CONCLUSION After 1 year of GH treatment in patients with LCH, metabolic variables and quality of life improved, with no new safety signals.
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Affiliation(s)
- Philippe Touraine
- Department of Endocrinology and Reproductive Medicine, Centre de Maladies Endocriniennes Rares de la Croissance et du Développement, Hôpital Universitaire Pitié Salpêtrière-Charles Foix, Sorbonne Université, Faculté de médecine, Paris Cedex 13, France
- Correspondence should be addressed to P Touraine;
| | - Yempabou Sagna
- Department of Internal Medicine, CHU Souro Sanou, Intitut Supérieur des Sciences de la Santé (IN.S.SA), Université Nazi Boni, Bobo-Dioulasso, Burkina Faso
| | | | - Pia Burman
- Department of Endocrinology, Skåne University Hospital, University of Lund, Malmö, Sweden
| | - André P Van Beek
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | | | | | - Ulla Feldt-Rasmussen
- Department of Endocrinology and Metabolism, Rigshospitalet, and Institute of Clinical Sciences, Copenhagen University, Copenhagen, Denmark
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Johannsson G, Touraine P, Feldt-Rasmussen U, Pico A, Vila G, Mattsson AF, Carlsson M, Korbonits M, van Beek AP, Wajnrajch MP, Gomez R, Yuen KCJ. Long-term Safety of Growth Hormone in Adults With Growth Hormone Deficiency: Overview of 15 809 GH-Treated Patients. J Clin Endocrinol Metab 2022; 107:1906-1919. [PMID: 35368070 PMCID: PMC9202689 DOI: 10.1210/clinem/dgac199] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Indexed: 01/16/2023]
Abstract
CONTEXT Data on long-term safety of growth hormone (GH) replacement in adults with GH deficiency (GHD) are needed. OBJECTIVE We aimed to evaluate the safety of GH in the full KIMS (Pfizer International Metabolic Database) cohort. METHODS The worldwide, observational KIMS study included adults and adolescents with confirmed GHD. Patients were treated with GH (Genotropin [somatropin]; Pfizer, NY) and followed through routine clinical practice. Adverse events (AEs) and clinical characteristics (eg, lipid profile, glucose) were collected. RESULTS A cohort of 15 809 GH-treated patients were analyzed (mean follow-up of 5.3 years). AEs were reported in 51.2% of patients (treatment-related in 18.8%). Crude AE rate was higher in patients who were older, had GHD due to pituitary/hypothalamic tumors, or adult-onset GHD. AE rate analysis adjusted for age, gender, etiology, and follow-up time showed no correlation with GH dose. A total of 606 deaths (3.8%) were reported (146 by neoplasms, 71 by cardiac/vascular disorders, 48 by cerebrovascular disorders). Overall, de novo cancer incidence was comparable to that in the general population (standard incidence ratio 0.92; 95% CI, 0.83-1.01). De novo cancer risk was significantly lower in patients with idiopathic/congenital GHD (0.64; 0.43-0.91), but similar in those with pituitary/hypothalamic tumors or other etiologies versus the general population. Neither adult-onset nor childhood-onset GHD was associated with increased de novo cancer risks. Neutral effects were observed in lipids/fasting blood glucose levels. CONCLUSION These final KIMS cohort data support the safety of long-term GH replacement in adults with GHD as prescribed in routine clinical practice.
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Affiliation(s)
- Gudmundur Johannsson
- Department of Endocrinology, Sahlgrenska University Hospital & Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, SE-413 45, Gothenburg, Sweden
| | - Philippe Touraine
- Department of Endocrinology and Reproductive Medicine, Center for Rare Endocrine and Gynecological Disorders, Sorbonne Université, Assistance Publique Hopitaux de Paris, Paris, France
| | - Ulla Feldt-Rasmussen
- Department of Endocrinology and Metabolism, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Clinical Science, Copenhagen University, Copenhagen, Denmark
| | - Antonio Pico
- Biomedical Research Networking Center in Rare Diseases (CIBERER), Institute of Health Carlos III (ISCIII), Madrid, Spain
- Hospital General Universitario de Alicante-Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Department of Clinical Medicine, Miguel Hernández University, Elche, Spain
| | - Greisa Vila
- Clinical Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | | | | | - Márta Korbonits
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - André P van Beek
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Michael P Wajnrajch
- Rare Disease, Biopharmaceuticals, Pfizer, New York, NY, USA
- Department of Pediatrics, New York University Langone Medical Center, New York, NY, USA
| | - Roy Gomez
- European Medical Affairs, Pfizer, Brussels, Belgium
| | - Kevin C J Yuen
- Correspondence: Kevin CJ Yuen, MD, Barrow Pituitary Center, Barrow Neurological Institute, 124 West Thomas Road, Suite 300, Phoenix, AZ 85013, USA.
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Amin MK, Ahmed HG, Selmy M, Gad SS. Correlation of body mass index to Ghrelin and IGF-1 among children with short stature. J Pediatr (Rio J) 2022; 98:276-281. [PMID: 34273273 PMCID: PMC9432066 DOI: 10.1016/j.jped.2021.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To assess the BMI among children with Growth Hormone Deficiency (GHD) and Idiopathic Short Stature (ISS) and its correlation to ghrelin, Growth Hormone (GH), and Insulin-like Growth Factor-1 (IGF-1) levels. METHODS A cross-sectional descriptive study in which 42 patients attending the Pediatric endocrine clinic were enrolled, allocated into two groups: group I: GHD children; group II: ISS children. Ghrelin, IGF-1 and GH in both groups were measured. RESULTS Ghrelin was significantly higher among GHD group (p < 0.001). Overall, there was a strong negative correlation between IGF-1 and ghrelin (r = -0.977, p-value = < 0.001) while a moderate positive correlation between ghrelin and BMI (r = 0.419, p-value = 0.006). There was a weak positive non-significant correlation between IGF-1 and BMI (r = 0.276, p-value = 0.077). In GHD group, there was a weak positive non-significant correlation between ghrelin and GHmax measurement (r = 0.052, p-value = 0.824), while a weak negative non-significant correlation between both variables in ISS group (r = -0.243, p-value = 0.288). In GHD group, there was a moderate positive correlation between ghrelin and BMI (r = 0.500, p-value = 0.021), but weak negative non-significant correlation between both variables in ISS group (r = -0.255, p-value = 0.265). CONCLUSION There was a negative feedback loop between ghrelin and IGF-1, whereas a positive feedback between ghrelin and BMI. BMI was more affected in the ISS group but was non-significantly correlated with ghrelin. There was no significant compensatory response of ghrelin suggesting its contribution to the pathogenesis of ISS.
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Affiliation(s)
- Mona Karem Amin
- Suez Canal University, Faculty of Medicine, Pediatrics and Neonatology Department, Ismailia, Egypt.
| | - Heba G Ahmed
- Port-Said General Hospital, Pediatrics Department, Port-Said, Egypt
| | - Mohamed Selmy
- Suez Canal University, Faculty of Medicine, Medical Biochemistry and Molecular Biology Department, Ismailia, Egypt
| | - Suzan S Gad
- Suez Canal University, Faculty of Medicine, Pediatrics and Neonatology Department, Ismailia, Egypt
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van der Meulen M, Zamanipoor Najafabadi AH, Broersen LHA, Schoones JW, Pereira AM, van Furth WR, Claessen KMJA, Biermasz NR. State of the Art of Patient-reported Outcomes in Acromegaly or GH Deficiency: A Systematic Review and Meta-analysis. J Clin Endocrinol Metab 2022; 107:1225-1238. [PMID: 34871425 PMCID: PMC9016456 DOI: 10.1210/clinem/dgab874] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Insight into the current landscape of patient-reported outcome (PRO) measures (PROM) and differences between PROs and conventional biochemical outcomes is pivotal for future implementation of PROs in research and clinical practice. Therefore, in studies among patients with acromegaly and growth hormone deficiency (GHD), we evaluated (1) used PROMs, (2) their validity, (3) quality of PRO reporting, (4) agreement between PROs and biochemical outcomes, and (5) determinants of discrepancies. EVIDENCE ACQUISITION We searched 8 electronic databases for prospective studies describing both PROs and biochemical outcomes in acromegaly and GHD patients. Quality of PRO reporting was assessed using the International Society for Quality of Life Research (ISOQOL) criteria. Logistic regression analysis was used to evaluate determinants. EVIDENCE SYNTHESIS Ninety studies were included (acromegaly: n = 53; GHD: n = 37). Besides nonvalidated symptom lists (used in 37% of studies), 36 formal PROMs were used [predominantly Acromegaly Quality of Life Questionnaire in acromegaly (43%) and Quality of Life-Assessment of Growth Hormone Deficiency in Adults in GHD (43%)]. Reporting of PROs was poor, with a median of 37% to 47% of ISOQOL items being reported per study. Eighteen (34%) acromegaly studies and 12 (32%) GHD studies reported discrepancies between PROs and biochemical outcomes, most often improvement in biochemical outcomes without change in PROs. CONCLUSIONS Prospective studies among patients with acromegaly and GHD use a multitude of PROMs, often poorly reported. Since a substantial proportion of studies report discrepancies between PROs and biochemical outcomes, PROMs are pivotal in the evaluation of disease activity. Therefore, harmonization of PROs in clinical practice and research by development of core outcome sets is an important unmet need.
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Affiliation(s)
- Merel van der Meulen
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands
- Correspondence: Merel van der Meulen, BSc, Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Amir H Zamanipoor Najafabadi
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands
- University Neurosurgical Center Holland, Leiden University Medical Center, Haaglanden Medical Centre and Haga Teaching Hospital, Leiden and The Hague, The Netherlands
| | - Leonie H A Broersen
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan W Schoones
- Directorate of Research Policy, Leiden University Medical Center, Leiden, The Netherlands
| | - Alberto M Pereira
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands
| | - Wouter R van Furth
- University Neurosurgical Center Holland, Leiden University Medical Center, Haaglanden Medical Centre and Haga Teaching Hospital, Leiden and The Hague, The Netherlands
| | - Kim M J A Claessen
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands
| | - Nienke R Biermasz
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands
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Autoimmune Hypophysitis with Late Renal Involvement: A Case Report. ENDOCRINES 2021. [DOI: 10.3390/endocrines2020016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We report a case of a 50-year-old male admitted to the Endocrinology Unit because of persistent headaches, nausea, feeling tired, sudden weight loss, cold intolerance, decreased appetite, and lack of sex interest. Diagnostic workup showed a 6-millimeter pituitary tumor without signs of compression, and a condition of progressive panhypopituitarism. After 12 months of hormone replacement therapy, the patient was hospitalized because of sudden weight gain, periorbital-peripheral edema, severe dyslipidemia, hypertension, and proteinuria. Corticosteroid therapy was shifted from oral to continuous intravenous infusion, and once the diagnosis of “immune complex-mediated glomerulonephritis with mesangial deposits suggestive for membranoproliferative glomerulonephritis type IIIIgG4-positive” was made, the immunosuppressant mycophenolate (1500 mg/day) was started. After a 6-month follow-up, the complete resolution of renal symptoms was accompanied by the disappearance of a pituitary lesion and the patient was back to prior hormone replacement therapy. Autoimmune hypophysitis (AH) is a rare autoimmune inflammatory disease of the pituitary gland that can impair hormone secretion and function. IgG4-hypophysitis is rare and is usually associated with other IgG4-related diseases. Herein, we describe a rare case of AH associated with late renal disease, and without any other organ involvement.
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10
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Strength training and growth hormone: effects on bone of Wistar rats. SPORT SCIENCES FOR HEALTH 2021. [DOI: 10.1007/s11332-021-00784-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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van Bunderen CC, Olsson DS. Growth hormone deficiency and replacement therapy in adults: Impact on survival. Rev Endocr Metab Disord 2021; 22:125-133. [PMID: 33068227 PMCID: PMC7979620 DOI: 10.1007/s11154-020-09599-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/01/2020] [Indexed: 12/23/2022]
Abstract
In a seminal paper from 1990, Rosen and Bengtsson suggested that hypopituitary patients with a presumed growth hormone (GH) deficiency (GHD) have an excess mortality. Later studies have confirmed this finding but have also shown that the cause of the increased risk of death in these patients is multifactorial, including unreplaced GHD as well as non-physiological replacement therapy of other deficiencies, the etiology of hypopituitarism, and the side effects of tumor treatment. Only a few studies have investigated mortality in hypopituitary patients with GHD receiving GH replacement therapy (GHRT): these studies are retrospective observational studies with a wide range of underlying diseases but most of them show a mortality that is not different from the general population. Even though the research field of survival in GHD patients with and without GHRT is lacking prospective randomized trials, the evidence suggests that GHD in hypopituitary patients contributes to an excess mortality and modern replacement therapy including GHRT will result in a mortality that is approaching normal. Herein, we review the literature in the field of survival in GHD patients with and without GHRT. In addition, we outline the most important issues when evaluating studies in this area.
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Affiliation(s)
- Christa C van Bunderen
- Department of Internal Medicine, Sub-section of Endocrinology, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, 1117, The Netherlands
- Division of Endocrinology, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, 6525 GA, The Netherlands
| | - Daniel S Olsson
- Department of Endocrinology, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden.
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, 405 30, Gothenburg, Sweden.
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Gasco V, Cambria V, Bioletto F, Ghigo E, Grottoli S. Traumatic Brain Injury as Frequent Cause of Hypopituitarism and Growth Hormone Deficiency: Epidemiology, Diagnosis, and Treatment. Front Endocrinol (Lausanne) 2021; 12:634415. [PMID: 33790864 PMCID: PMC8005917 DOI: 10.3389/fendo.2021.634415] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 02/16/2021] [Indexed: 12/12/2022] Open
Abstract
Traumatic brain injury (TBI)-related hypopituitarism has been recognized as a clinical entity for more than a century, with the first case being reported in 1918. However, during the 20th century hypopituitarism was considered only a rare sequela of TBI. Since 2000 several studies strongly suggest that TBI-mediated pituitary hormones deficiency may be more frequent than previously thought. Growth hormone deficiency (GHD) is the most common abnormality, followed by hypogonadism, hypothyroidism, hypocortisolism, and diabetes insipidus. The pathophysiological mechanisms underlying pituitary damage in TBI patients include a primary injury that may lead to the direct trauma of the hypothalamus or pituitary gland; on the other hand, secondary injuries are mainly related to an interplay of a complex and ongoing cascade of specific molecular/biochemical events. The available data describe the importance of GHD after TBI and its influence in promoting neurocognitive and behavioral deficits. The poor outcomes that are seen with long standing GHD in post TBI patients could be improved by GH treatment, but to date literature data on the possible beneficial effects of GH replacement therapy in post-TBI GHD patients are currently scarce and fragmented. More studies are needed to further characterize this clinical syndrome with the purpose of establishing appropriate standards of care. The purpose of this review is to summarize the current state of knowledge about post-traumatic GH deficiency.
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Ricci Bitti S, Franco M, Albertelli M, Gatto F, Vera L, Ferone D, Boschetti M. GH Replacement in the Elderly: Is It Worth It? Front Endocrinol (Lausanne) 2021; 12:680579. [PMID: 34211437 PMCID: PMC8239420 DOI: 10.3389/fendo.2021.680579] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 06/02/2021] [Indexed: 11/24/2022] Open
Abstract
Growth hormone (GH), once the age of linear growth is completed, continues to play a fundamental role for the human body. In adulthood, GH contributes to regulate muscle, cardiovascular and bone metabolism. The same happens in old age, although there is less data on the effect of GH in the elderly. Regardless the age of onset, a reduced quality of life (QoL), an increased cardiovascular risk and an accelerated age-related decline in physical strength have been demonstrated in the elderly with GH deficiency (EGHD). In adults with GH deficiency (AGHD), recent studies suggest a role of GH replacement therapy (GHrt) in improving lean/fat mass ratio, blood pressure, lipid profile, bone metabolism and QoL. Despite these recent studies, there is still a lack of randomized controlled trials proving these positive effects in EGHD. Moreover, the lack of a long-term positive outcome on mortality, and the cost of GHrt could often impact on treatment decision-making and lead to postpone or avoid the prescription. The aim of this mini-review is to summarize the available data on GHrt in EGHD, in order to highlight its weaknesses and strengths and to provide directions to clinicians that will help in the management of this specific set of patients.
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Affiliation(s)
- Silvia Ricci Bitti
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties, School of Medical and Pharmaceutical Sciences, University of Genova, Genova, Italy
| | - Marta Franco
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties, School of Medical and Pharmaceutical Sciences, University of Genova, Genova, Italy
| | - Manuela Albertelli
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties, School of Medical and Pharmaceutical Sciences, University of Genova, Genova, Italy
- Endocrinology Unit, IRCCS Policlinico San Martino, Genova, Italy
| | - Federico Gatto
- Endocrinology Unit, IRCCS Policlinico San Martino, Genova, Italy
| | - Lara Vera
- Endocrinology Unit, IRCCS Policlinico San Martino, Genova, Italy
| | - Diego Ferone
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties, School of Medical and Pharmaceutical Sciences, University of Genova, Genova, Italy
- Endocrinology Unit, IRCCS Policlinico San Martino, Genova, Italy
| | - Mara Boschetti
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties, School of Medical and Pharmaceutical Sciences, University of Genova, Genova, Italy
- Endocrinology Unit, IRCCS Policlinico San Martino, Genova, Italy
- *Correspondence: Mara Boschetti,
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Wang Y, Zheng X, Xie X, Qian W, Ren Z, Chen Y, Wu X, Liao K, Ren W. Body fat distribution and circulating adipsin are related to metabolic risks in adult patients with newly diagnosed growth hormone deficiency and improve after treatment. Biomed Pharmacother 2020; 132:110875. [PMID: 33254428 DOI: 10.1016/j.biopha.2020.110875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 10/08/2020] [Accepted: 10/09/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The relationships between body fat distribution, the adipokine adipsin and metabolic risks were assessed in patients with adult growth hormone deficiency (AGHD) before and after growth hormone (GH) treatment. METHODS Sixty newly diagnosed AGHD patients were included in our study, 24 of whom were evaluated after at least one year of GH treatment. Anthropometric parameters, glucolipid metabolism and the adipokine adipsin were measured. Visceral adipose tissue (VAT) and body composition were evaluated using a dual-energy X-ray-absorptiometry (DXA) scanner. RESULTS At baseline, the higher VAT group had worse glucolipid metabolism parameters. Basal GH was negatively associated with VAT (r=-0.277, p = 0.045), while minimal correlations were found with fat mass depots, such as limbs and trunk fat (all p > 0.05). Adipsin was correlated with total body fat (r = 0.543, p < 0.001), VAT (r = 0.563, p < 0.001) and insulin resistance (r = 0.353, p = 0.006). The effect of GH administration on fat distribution was mainly reflected in the reduction in VAT. Partial improvements were found in lipid profiles, including increased high-density lipoprotein (HDL) and decreases in triglycerides (TGs) and lipoprotein(a), while glucose metabolism showed little change. The adipsin level also decreased significantly. The best predictors of VAT at baseline were trunk fat and IGF-I, and after treatment, VAT was predicted by decreased adipsin and an increase in lean mass. CONCLUSIONS (1) VAT is an important metabolic risk factor for AGHD patients. (2) GH treatment decreased body fat predominantly in the visceral and central fat depots. (3) The lipid profiles partially improved after treatment, while glucose metabolism showed little change.
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Affiliation(s)
- Yunting Wang
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoya Zheng
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xin Xie
- Department of Endocrinology, Bishan Hospital of Chongqing, Chongqing, China
| | - Wenjie Qian
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ziyu Ren
- Department of Endocrinology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yue Chen
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xun Wu
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kun Liao
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Ren
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Höybye C, Beck-Peccoz P, Simsek S, Zabransky M, Zouater H, Stalla G, Murray RD. Safety of current recombinant human growth hormone treatments for adults with growth hormone deficiency and unmet needs. Expert Opin Drug Saf 2020; 19:1539-1548. [PMID: 33089723 DOI: 10.1080/14740338.2020.1839410] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Growth hormone (GH) deficiency (GHD) in adults is characterized by abnormal body composition, unfavorable cardiovascular risk factors, and poor quality of life. The diagnosis is made within appropriate clinical settings and according to established guidelines. Numerous studies have shown that GH treatment improves body composition, cardiovascular risk factors, physical capacity, and quality of life while issues on safety, in particular long-term safety, remain. AREAS COVERED Short- and long-term safety of GH replacement in adults with GHD. EXPERT OPINION Adults with GHD are an inhomogeneous group of patients and GH replacement requires individual considerations. Most adverse effects are mild and transient and related to fluid retention and GH dose. In patients without comorbidities long-term GH treatment is safe and development of diabetes, cardiovascular disease, or tumors are not increased. Furthermore, mortality is not increased. Patients with risk factors should be identified before GH treatment is initiated and an optimal balance between benefit and risk established. Studies with sufficient duration and power to identify the development of cardiovascular diseases and cancers are still awaited. Effective management of comorbidities can be expected to decrease morbidity and mortality and improve quality of life. Studies with long-acting GH formulations are ongoing and available data indicate similar effects and short-time safety.
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Affiliation(s)
- Charlotte Höybye
- Department Molecular Medicine and Surgery, Karolinska institute and Department of Endocrinology, Karolinska University Hospital , Stockholm, Sweden
| | - Paolo Beck-Peccoz
- Clinical Sciences and Community Health, Fondazione Istituto Di Ricovero E Cura a Carattere Scientifico Cà Granda Ospedale Maggiore Policlinico , Milano, Italy
| | - Suat Simsek
- Internal medicine, Northwest Clinics , Netherlands
| | | | | | - Günter Stalla
- Medicover Neuroendokrinologie , Munich, Germany.,Planck Institute of psychiatry, Medizinische Klinik Und Poliklinik IV Der Ludwig-Maximilians-Universität , Munich, Germany
| | - Robert D Murray
- Leeds Centre for Diabetes & Endocrinology, St James's University Hospital , Leeds, UK
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He X, Barkan AL. Growth hormone therapy in adults with growth hormone deficiency: a critical assessment of the literature. Pituitary 2020; 23:294-306. [PMID: 32060708 DOI: 10.1007/s11102-020-01031-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Growth hormone (GH) therapy has been studied as treatment for clinical manifestations of adult-onset growth hormone deficiency (AO-GHD), including cardiovascular risk, bone health, and quality of life. Patients with AO-GHD typically also have significant history of pituitary pathology and hypopituitarism, which raises the question of what proportion of their clinical presentation can be attributed to GHD alone. Currently, much of the existing data for GH therapy in AO-GHD come from uncontrolled retrospective studies and observational protocols. These considerations require careful reassessment of the role of GH as a therapeutic agent in adult patients with hypopituitarism. METHODS We contrast results from placebo-controlled trials with those from uncontrolled and retrospective studies for GH replacement in patients with hypopituitarism. We also examine the evidence for the manifestations of AO-GHD being attributed to GHD alone, as well as the data on adults with congenital, life-long untreated isolated GHD. RESULTS The evidence for increased morbidity and mortality in hypopituitary patients with GHD, and for the benefits of GH therapy, are conflicting. There remains the possibility that the described clinical manifestations of AO-GHD may not be due to GHD alone, but may also be related to underlying pituitary pathology, treatment history and suboptimal hormone replacement. CONCLUSIONS In the setting of inconsistent data on the benefits of GH therapy, treatment of AO-GHD remains an individualized decision. There is a need for more randomized, placebo-controlled studies to evaluate the long-term outcomes of GH therapy in adults with hypopituitarism.
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Affiliation(s)
- Xin He
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan, Domino's Farms, Lobby G, Suite 1500, 24 Frank Lloyd Wright Drive, Ann Arbor, MI, 48106, USA
| | - Ariel L Barkan
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan, Domino's Farms, Lobby G, Suite 1500, 24 Frank Lloyd Wright Drive, Ann Arbor, MI, 48106, USA.
- Department of Neurosurgery, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA.
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Towards a Göttingen minipig model of adult onset growth hormone deficiency: evaluation of stereotactic electrocoagulation method. Heliyon 2019; 5:e02892. [PMID: 31844758 PMCID: PMC6895662 DOI: 10.1016/j.heliyon.2019.e02892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/24/2019] [Accepted: 11/18/2019] [Indexed: 01/09/2023] Open
Abstract
Background Adult onset growth hormone (GH) deficiency (AGDH) is a potentially underdiagnosed condition, caused by damage to the pituitary gland. AGHD is treated with growth hormone replacement therapy. A large variety of clinical symptoms and changes in the metabolic homeostasis can be observed and quantified. New large animal models are needed for future drug development. New method In this study, we evaluate methods for a new large non-primate animal model of GH deficiency in post pubertal Göttingen Minipigs (minipig). Lesions in the pituitary gland were made by stereotaxic monopolar thermo-coagulation guided by magnetic resonance imaging (MRI), and pituitary function was evaluated using insulin tolerance test (ITT) with measurements of growth hormone secretion induced by hypoglycemia. Results Lesions were successfully applied to the pituitary gland without any damage to surrounding tissue including the hypothalamus, which was confirmed by post-operative MRI and post mortem histology. Plasma levels of GH during ITT showed no decrease in secreted levels one week after surgery compared to levels obtained before surgery. Comparison with existing methods Compared to other GH insufficiency models, eloquent brain tissue is spared. Furthermore, alternatively to rodent models, a large animal model would allow the use of human intended equipment to evaluate disease. Using the minipig avoids social, economical and ethical issues, compared with primates. Conclusion The lesions did not remove all GH production, but proof of concept is demonstrated. In addition, the ITT is presented as a safe and efficient method to diagnose GH deficiency in minipigs.
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Cañete MD, Valle‐Martos R, Martos R, Cañete R, Valle M, Jiménez‐Reina L. Effects of growth hormone therapy on metabolic parameters, adipokine and endothelial dysfunction in prepuberal children. Acta Paediatr 2019; 108:2027-2033. [PMID: 31087421 DOI: 10.1111/apa.14849] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/13/2019] [Accepted: 05/10/2019] [Indexed: 12/20/2022]
Abstract
AIM To determine whether non-obese prepubertal children with growth hormone deficiency (GHD) present changes in lipid metabolism, and adipokines, and to assess the short-term effects of growth hormone (GH) treatment on these parameters. METHODS Prospective observational follow-up and case-control (36 GHD children and 38 healthy children) study lasted for six months. Means of values from groups were compared, control group versus GHD baseline group, and GHD baseline group versus GHD after six months of GH replacement therapy. Lipid profile, glucose, insulin, homeostatic model assessment - insulin resistance (HOMA-IR), leptin, adiponectin and soluble intercellular adhesion molecule-1 (sICAM-1) were all analysed. RESULTS Growth hormone deficiency children show higher baseline levels of total cholesterol, LDL cholesterol, triglycerides, Apo B and sICAM-1, but lower levels of free fatty acids, insulin and HOMA-IR. After six months of treatment, cholesterol, LDL cholesterol, Apo B, T cholesterol/HDL cholesterol, insulin, HOMA-IR and leptin levels decreased. The changes in insulin and HOMA-IR levels correlated inversely with the changes in HDL cholesterol and Apo A1 levels. A correlation was also observed between the changes in adiponectin levels and the changes in HDL cholesterol and Apo A1 levels. Variations in leptin levels were correlated with changes in triglycerides. CONCLUSION Prepubertal non-obese GHD children present altered lipid profiles and adipokine levels. Replacement therapy with GH improves these variables.
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Affiliation(s)
| | | | - Rosario Martos
- Pediatric Unit Valle de los Pedroches Hospital Córdoba Spain
| | - Ramón Cañete
- Pediatric Endocrinology Section, Service of Pediatrics Reina Sofía University Hospital, IMIBIC, CIBEROBN Córdoba Spain
| | - Miguel Valle
- Clinical Analysis Services Valle de los Pedroches Hospital Pozoblanco, Córdoba Spain
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Yuen KCJ, Llahana S, Miller BS. Adult growth hormone deficiency: clinical advances and approaches to improve adherence. Expert Rev Endocrinol Metab 2019; 14:419-436. [PMID: 31721610 DOI: 10.1080/17446651.2019.1689119] [Citation(s) in RCA: 10] [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: 07/05/2019] [Accepted: 11/01/2019] [Indexed: 12/17/2022]
Abstract
Introduction: There have been significant clinical advances in the understanding of the diagnosis and benefits of long-term recombinant human growth hormone (rhGH) replacement in adults with GH deficiency (GHD) since its approval in 1996 by the United States Food and Drug Administration.Areas covered: We searched PubMed, Medline, CINAHL, EMBASE and PsychInfo databases between January 2000 and June 2019 for published studies evaluating adults with GHD. We reviewed the data of the oral macimorelin test compared to the GHRH plus arginine and the insulin tolerance tests that led to its approval by the United States FDA and European Medicines Agency for adult diagnostic testing. We summarize the clinical advances of long-term benefits of rhGH therapy and the potential effects of GH receptor polymorphisms on individual treatment responsiveness. We identify that non-adherence and discontinuation rates are high and recommend strategies to support patients to improve adherence. We also provide an overview of several long-acting GH (LAGH) preparations currently under development and their potential role in improving treatment adherence.Expert opinion: This article summarizes recent clinical advances in rhGH replacement therapy, the biological and molecular aspects that may influence rhGH action, and offers practical strategies to enhance adherence in adults with GHD.
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Affiliation(s)
- Kevin C J Yuen
- Barrow Pituitary Center, Barrow Neurological Institute, University of Arizona College of Medicine and Creighton School of Medicine, Phoenix, AZ, USA
| | - Sofia Llahana
- Division of Nursing, School of Health Sciences, City University of London, London, UK
| | - Bradley S Miller
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
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Li S, Mao J, Wang X, Nie M, Wu X. Osteonecrosis of Femoral Head is Associated with Congenital Multiple Pituitary Hormone Deficiency: Report of Three Cases and Literature Review. Endocr Res 2019; 44:153-158. [PMID: 30966827 DOI: 10.1080/07435800.2019.1601212] [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] [Indexed: 10/27/2022]
Abstract
Objective: Pituitary hormones are critical for bone development and maturation. It is currently unknown whether congenital multiple pituitary hormone deficiency (CMPHD) is associated with osteonecrosis of femoral head (ONFH). Methods: Clinical presentations and hormonal profiles of three patients with CMPHD and ONFH were retrospectively described. The incidence of ONFH in this population was studied. Results: (1) Congenital hypopituitarism was diagnosed in three patients. Femoral epiphyseal fusion in these patients was markedly delayed, and they had very low bone mineral density. (2) Hip pain, which is the main presentation of ONFH, occurred at the age of 20-30 years. ONFH induced by excessive glucocorticoids was excluded. (3) The estimated incidence of ONFH was approximately 694:100,000. Conclusions: CMPHD, especially a lack of growth and sex hormones, may contribute to ONFH.
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Affiliation(s)
- Shuying Li
- Department of Endocrinology, Peking Union Medical College Hospital, Key Laboratory of Endocrinology, Ministry of Health , Beijing , China
| | - Jiangfeng Mao
- Department of Endocrinology, Peking Union Medical College Hospital, Key Laboratory of Endocrinology, Ministry of Health , Beijing , China
| | - Xi Wang
- Department of Endocrinology, Peking Union Medical College Hospital, Key Laboratory of Endocrinology, Ministry of Health , Beijing , China
| | - Min Nie
- Department of Endocrinology, Peking Union Medical College Hospital, Key Laboratory of Endocrinology, Ministry of Health , Beijing , China
| | - Xueyan Wu
- Department of Endocrinology, Peking Union Medical College Hospital, Key Laboratory of Endocrinology, Ministry of Health , Beijing , China
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Growth Hormone Deficiency Following Traumatic Brain Injury. Int J Mol Sci 2019; 20:ijms20133323. [PMID: 31284550 PMCID: PMC6651180 DOI: 10.3390/ijms20133323] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 06/28/2019] [Accepted: 07/04/2019] [Indexed: 02/06/2023] Open
Abstract
Traumatic brain injury (TBI) is fairly common and annually affects millions of people worldwide. Post traumatic hypopituitarism (PTHP) has been increasingly recognized as an important and prevalent clinical entity. Growth hormone deficiency (GHD) is the most common pituitary hormone deficit in long-term survivors of TBI. The pathophysiology of GHD post TBI is thought to be multifactorial including primary and secondary mechanisms. An interplay of ischemia, cytotoxicity, and inflammation post TBI have been suggested, resulting in pituitary hormone deficits. Signs and symptoms of GHD can overlap with those of TBI and may delay rehabilitation/recovery if not recognized and treated. Screening for GHD is recommended in the chronic phase, at least six months to a year after TBI as GH may recover in those with GHD in the acute phase; conversely, it may manifest in those with a previously intact GH axis. Dynamic testing is the standard method to diagnose GHD in this population. GHD is associated with long-term poor medical outcomes. Treatment with recombinant human growth hormone (rhGH) seems to ameliorate some of these features. This review will discuss the frequency and pathophysiology of GHD post TBI, its clinical consequences, and the outcomes of treatment with GH replacement.
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Höybye C, Faseh L, Himonakos C, Pielak T, Eugen-Olsen J. Serum soluble urokinase plasminogen activator receptor (suPAR) in adults with growth hormone deficiency. Endocr Connect 2019; 8:772-779. [PMID: 31151091 PMCID: PMC6547304 DOI: 10.1530/ec-19-0159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 05/10/2019] [Indexed: 12/27/2022]
Abstract
Growth hormone deficiency (GHD) syndrome is associated with adverse levels of several risk factors for cardiovascular diseases (CVD), including metabolic inflammation. However, the impact of GHD and GH treatment on low-grade inflammation is unknown. The aim of the study was to establish the level of the low-grade inflammation biomarker soluble urokinase plasminogen activator receptor (suPAR) in adults with GHD and the response to long-term GH treatment. Measurements of suPAR and CRP were performed in bio-bank serum samples from 72 adults, 34 males and 38 females, with GHD before and during at least 5 years of GH treatment. Mean age was 52.5 ± 15.5 years, BMI 27.3 ± 5 kg/m2. Clinical evaluations and blood sampling were performed at routine visits. Data on demography, anthropometry, lab results and clinical events were retrieved from post-marketing surveillance study databases and medical records. suPAR and high-sensitive (hs) CRP were analysed using ELISA and immunochemistry, respectively. At baseline blood pressure, lipid profile and fasting glucose were within the normal reference range. Baseline geometric mean and 95% CI of suPAR was 2.9 (2.7-3.3) ng/mL and of CRP 2.3 (0.6-4.0) mg/L. Mean follow-up was 8 ± 2 years. The suPAR levels remained stable during follow-up, although individual increases were seen on occurrence or presence of co-morbidities. In contrast, levels of CRP decreased. In conclusion, the decrease in CRP and indirectly the absence of an expected increase in suPAR over time indicates a favourable effect of GH on low-grade inflammation.
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Affiliation(s)
- Charlotte Höybye
- Patient Area Endocrinology and Nephrology, Infection and Inflammation Theme, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Correspondence should be addressed to C Höybye:
| | - Laia Faseh
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Christos Himonakos
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Department of Medicine, Karlstad Hospital, Karlstad, Sweden
| | | | - Jesper Eugen-Olsen
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
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Loftus J, Camacho-Hubner C, Hey-Hadavi J, Goodrich K. Targeted literature review of the humanistic and economic burden of adult growth hormone deficiency. Curr Med Res Opin 2019; 35:963-973. [PMID: 30411985 DOI: 10.1080/03007995.2018.1546682] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Quality of life (QoL) and health economic data are becoming increasingly important factors in healthcare decision making. While there is a wealth of information establishing the benefit of growth hormone (GH) replacement therapy in adults with growth hormone deficiency (aGHD), recent reviews on the QoL and health economic impact of aGHD and the effect of treatment on these factors is limited. OBJECTIVE The aim of this article is to summarize the impact of early and sustained treatment on the QoL and economic burden of aGHD by conducting a targeted literature review. METHODS Standard electronic databases, including PubMed and the Cochrane collaboration website, were searched for publications between January 2006 and July 2016 for evidence of the humanistic and economic burden of aGHD. Search terms included growth hormone deficiency, health-related quality of life, HRQoL, patient-reported outcomes, outcome assessment, well-being and adherence. RESULTS The literature search identified 732 initial hits and a final 14 publications were included. The analysis showed that the economic burden of aGHD is largely driven by the productivity losses associated with the disease. This is because most patients with aGHD are of working age and the QoL domains (memory & concentration and energy & vitality) most commonly affected by aGHD severely impair a person's ability to work and may limit their contribution to society. CONCLUSION Untreated aGHD can seriously affect patients' functioning. Early and continued treatment with GH replacement therapy could potentially improve the QoL and reduce the economic burden associated with aGHD. This review has limitations: only English language articles published since January 2006 were included and many of the studies were conducted in the Nordic countries; it is unclear how representative these studies are of the population as a whole. This was a literature review and not a systematic review, as it was thought to be unlikely that, in this rare disease, any additional publications would have been identified. Overall, this review reveals a paucity of data in this underserved population and points to research gaps which could be addressed with new studies.
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Sgrò P, Sansone M, Sansone A, Sabatini S, Borrione P, Romanelli F, Di Luigi L. Physical exercise, nutrition and hormones: three pillars to fight sarcopenia. Aging Male 2019; 22:75-88. [PMID: 29451419 DOI: 10.1080/13685538.2018.1439004] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Sarcopenia is a pathophysiological condition diffused in elderly people; it represents a social issue due to the longer life expectancy and the growing aging population. It affects negatively quality of life and it represents a risk factor for other pathologies, such as diabetes, cardiovascular disease, and obesity. No silver bullet exists to hinder sarcopenia, but it may be counteracted by physical exercise, nutrition, and a proper endocrine milieu. Indeed, we aim to analyze the scientific literature to give to clinician effective advices to counteract sarcopenia. Main text: Physical exercise, proper nutrition, optimized hormonal homeostasis represent the three pillars to fight sarcopenia. Physical exercise represents the most effective remedy to face sarcopenia, in particular if it is combined with a proper diet and with an adequate endocrine milieu. Consistency in training, adequate daily protein intake and eugonadism seems to be the keys to fight sarcopenia. The combination of these three pillars might act synergistically. CONCLUSIONS Optimization of these factors may increase their efficiency; however, scientific data may be sometimes confusing so far. Therefore, we aim to give practical advices to clinician to identify and to highlight the most important aspects in each of these three factors that should be addressed.
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Affiliation(s)
- Paolo Sgrò
- a Department of Movement, Human and Health Sciences, Unit of Endocrinology , Università degli Studi di Roma "Foro Italico" , Rome , Italy
| | - Massimiliano Sansone
- b Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology , Sapienza - Università di Roma , Rome , Italy
| | - Andrea Sansone
- b Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology , Sapienza - Università di Roma , Rome , Italy
| | - Stefania Sabatini
- c Department of Movement, Human and Health Sciences, Unit of Biology, Genetics and Biochemistry , Università degli Studi di Roma "Foro Italico" , Rome , Italy
| | - Paolo Borrione
- d Department of Movement, Human and Health Sciences, Unit of Internal Medicine , Università degli Studi di Roma "Foro Italico" , Rome , Italy
| | - Francesco Romanelli
- b Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology , Sapienza - Università di Roma , Rome , Italy
| | - Luigi Di Luigi
- a Department of Movement, Human and Health Sciences, Unit of Endocrinology , Università degli Studi di Roma "Foro Italico" , Rome , Italy
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Simultaneously avoiding the hippocampus and hypothalamic-pituitary axis during whole brain radiotherapy: A planning study. Med Dosim 2019; 44:130-135. [DOI: 10.1016/j.meddos.2018.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 04/08/2018] [Accepted: 04/09/2018] [Indexed: 01/19/2023]
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Rochira V, Mossetto G, Jia N, Cannavo S, Beck-Peccoz P, Aimaretti G, Ambrosio MR, Di Somma C, Losa M, Ferone D, Lubrano C, Scaroni C, Giampietro A, Corsello SM, Poggi M. Analysis of characteristics and outcomes by growth hormone treatment duration in adult patients in the Italian cohort of the Hypopituitary Control and Complications Study (HypoCCS). J Endocrinol Invest 2018. [PMID: 29536433 PMCID: PMC6208780 DOI: 10.1007/s40618-018-0860-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To examine differences in effects according to growth hormone (GH) treatment duration in adult GH-deficient patients. METHODS In the Italian cohort of the observational Hypopituitary Control and Complications Study, GH-treated adults with GH deficiency (GHD) were grouped by duration of treatment; ≤ 2 years (n = 451), > 2 to ≤ 6 years (n = 387) and > 6 years (n = 395). Between-group differences in demographics, medical history, physical characteristics, insulin-like growth factor-I standard deviation score (IGF-I SDS) and lipid profile at baseline, last study visit and changes from baseline to last study visit were assessed overall, for adult- and childhood-onset GHD and by gender using ANOVA for continuous variables and Chi-squared test for categorical variables. RESULTS At baseline, treatment duration groups did not differ significantly for age, gender, body mass index, GHD onset, IGF-I SDS, lipid profile, and quality of life. Mean initial GH dose did not differ significantly according to treatment duration group in any subgroup, except female patients, with highest mean dose seen in the longest duration group. In the longest duration group for patients overall, adult-onset patients and male patients, there were significant decreases in GH dose from baseline to last visit, and in total and low-density lipoprotein (LDL)-cholesterol concentrations. IGF-I SDS increased, to a greater extent, in the longest duration group for patients overall and female patients. CONCLUSIONS The results show that long-term GH treatment is associated with decreasing GH dose, increased IGF-I, decreased LDL-cholesterol and the presence of surrogate markers that help to give confidence in a diagnosis of GHD.
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Affiliation(s)
- V Rochira
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Via Pietro Giardini 1355, 41126, Modena, Italy.
| | | | - N Jia
- Eli Lilly, Indianapolis, IN, USA
| | - S Cannavo
- University of Messina, Messina, Italy
| | - P Beck-Peccoz
- IRCCS Policlinico, University of Milan, Milan, Italy
| | - G Aimaretti
- University of Eastern Piedmont, Novara, Italy
| | | | | | - M Losa
- IRCCS San Raffaele Hospital, Milan, Italy
| | - D Ferone
- DiMI, IRCCS AOU San Martino-IST University of Genova, Genoa, Italy
| | - C Lubrano
- La Sapienza University, Policlinico Umberto I, Rome, Italy
| | - C Scaroni
- Medical Sciences DIMED, University of Padova, Padua, Italy
| | | | | | - M Poggi
- St. Andrea Hospital, Rome, Italy
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Chen M, Gan D, Luo Y, Rampersad S, Xu L, Yang S, Li N, Li H. Effect of recombinant human growth hormone therapy on blood lipid and carotid intima-media thickness in children with growth hormone deficiency. Pediatr Res 2018; 83:954-960. [PMID: 29206809 PMCID: PMC6023698 DOI: 10.1038/pr.2017.271] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 10/05/2017] [Indexed: 11/09/2022]
Abstract
BackgroundReports on the association between growth hormone deficiency (GHD) and cardiovascular risk factors in children are limited. We aim to investigate the effect of different doses of recombinant human growth hormone (rhGH) therapy on blood lipid and carotid intima-media thickness (cIMT) in Chinese GHD children.MethodsNinety children, including sixty isolated GHD children and thirty healthy children, were enrolled. GHD children were randomly divided into two groups (A and B) according to the rhGH dose given: group A received 0.23 mg/kg/week and group B received 0.35 mg/kg/week for 12 months. The TC, TG, LDL-C, HDL-C, and cIMT at baseline and after treatment were measured.ResultsThe height, weight, and height velocity improved significantly over 12 months of rhGH therapy in all GHD children. At baseline, GHD children in both the treatment groups showed significantly higher total cholesterol (TC), triglyceride (TG), low-density lipoprotein-cholesterol (LDL-C), cIMT, and lower high-density lipoprotein-cholesterol (HDL-C) than healthy children (all P≤0.033). After the 12-month rhGH therapy, a significant decrease in the TC, TG, LDL-C, and cIMT, as well as a significant increase in the HDL-C (P≤0.046), was observed in the GHD children, with change in the group B being even more marked.ConclusionsThe RhGH replacement therapy in GHD children can improve both the blood lipid profile and carotid intima-media thickness, with higher-dose rhGH therapy showing superior effects.
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Affiliation(s)
- Ming Chen
- Department of Endocrinology, Shanghai Tenth People’s Hospital, Shanghai, China
| | - Dongmei Gan
- Department of Endocrinology, Ningbo Women and Children’s Hospital, Ningbo, China
| | - Yili Luo
- Department of Endocrinology, Shanghai Tenth People’s Hospital, Shanghai, China
| | - Sharvan Rampersad
- Department of Endocrinology, Shanghai Tenth People’s Hospital, Shanghai, China
| | - Lu Xu
- Department of Endocrinology, Shanghai Tenth People’s Hospital, Shanghai, China
| | - Shaoling Yang
- Department of Endocrinology, Shanghai Tenth People’s Hospital, Shanghai, China
| | - Nan Li
- Department of Endocrinology, Shanghai Tenth People’s Hospital, Shanghai, China
| | - Hong Li
- Department of Endocrinology, Shanghai Tenth People’s Hospital, Shanghai, China,.
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Treatment with Growth Hormone for Adults with Growth Hormone Deficiency Syndrome: Benefits and Risks. Int J Mol Sci 2018; 19:ijms19030893. [PMID: 29562611 PMCID: PMC5877754 DOI: 10.3390/ijms19030893] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 03/07/2018] [Accepted: 03/14/2018] [Indexed: 12/14/2022] Open
Abstract
Pharmacological treatment of growth hormone deficiency (GHD) in adults began in clinical practice more than 20 years ago. Since then, a great volume of experience has been accumulated on its effects on the symptoms and biochemical alterations that characterize this hormonal deficiency. The effects on body composition, muscle mass and strength, exercise capacity, glucose and lipid profile, bone metabolism, and quality of life have been fully demonstrated. The advance of knowledge has also taken place in the biological and molecular aspects of the action of this hormone in patients who have completed longitudinal growth. In recent years, several epidemiological studies have reported interesting information about the long-term effects of GH replacement therapy in regard to the possible induction of neoplasms and the potential development of diabetes. In addition, GH hormone receptor polymorphism could potentially influence GH therapy. Long-acting GH are under development to create a more convenient GH dosing profile, while retaining the excellent safety, efficacy, and tolerability of daily GH. In this article we compile the most recent data of GH replacement therapy in adults, as well as the molecular aspects that may condition a different sensitivity to this treatment.
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Krzyzanowska-Mittermayer K, Mattsson AF, Maiter D, Feldt-Rasmussen U, Camacho-Hübner C, Luger A, Abs R. New Neoplasm During GH Replacement in Adults With Pituitary Deficiency Following Malignancy: A KIMS Analysis. J Clin Endocrinol Metab 2018; 103:523-531. [PMID: 29228199 DOI: 10.1210/jc.2017-01899] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 11/30/2017] [Indexed: 01/27/2023]
Abstract
CONTEXT Data on the association between growth hormone (GH) replacement in patients with GH deficiency (GHD) after malignancies and new neoplasms show conflicting results. OBJECTIVE To clarify the incidence of new malignant neoplasm in childhood-onset (CO) and adult-onset (AO) adult cancer survivors (CSs). DESIGN Retrospective comparison of CO-CS and AO-CS with CO idiopathic GHD (IGHD) and AO nonfunctioning pituitary adenoma (NFPA) patients and with the general population [standardized incidence ratio (SIR)]. SETTING Data from the Pfizer International Metabolic Database study (KIMS). PATIENTS CO-CS [n = 349; 50.4% females; mean baseline (MBL) IGF-I standard deviation score (SDS), -2.4], IGHD (n = 619; 35.7% females; MBL IGF-I SDS, -3.4), AO-CS (n = 174; 42.5% females; MBL IGF-I SDS, -1.4), and NFPA (n = 2449; 38.1% females; MBL IGF-I SDS, -1.0). MAIN OUTCOME MEASURES SIRs of malignant neoplasms. RESULTS After a median follow-up of 5.9 years (2192 patient-years), 15 CO-CS (4.3%) had developed 16 new neoplasms. The SIR was 10.4 [95% confidence interval (CI), 5.9 to 16.9] and 6.5 (95% CI, 3.0 to 12.4) after exclusion of seven patients with skin cancers. In IGHD, three malignant neoplasms (0.5%) were observed after a median follow-up of 5.4 years (3908 patient-years; SIR, 0.47; 95% CI, 0.09 to 1.37). New malignant neoplasms occurred in three AO-CS (1.7%; SIR, 1.1; 95% CI, 0.2 to 3.2) and 146 NFPA patients (153 cases, 6.0%; SIR, 1.1; 95% CI, 0.9 to 1.2) after a median follow-up of 4.9 (1024 patient-years) and 5.6 years (15,215 patient-years). CONCLUSIONS The risk of second malignant neoplasms was increased in CO-CS but not in AO-CS, which illustrates the need to closely follow patients on GH replacement because of a prior malignancy.
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Affiliation(s)
| | | | - Dominique Maiter
- UCL St Luc Hospital, Department of Endocrinology and Nutrition, Brussels, Belgium
| | - Ulla Feldt-Rasmussen
- Copenhagen University, Rigshospitalet, Department of Endocrinology, Copenhagen, Denmark
| | | | - Anton Luger
- Division of Endocrinology and Metabolism, Department of Medicine III, Medical University and General Hospital of Vienna, Vienna, Austria
| | - Roger Abs
- Antwerp Centre for Endocrinology, Antwerp, Belgium
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Gómez-Guzmán E, Cañete MD, Valle-Martos R, Cañete R, Valle M, Jiménez-Reina L, Caballero-Villarraso J. Short-Term Evaluation of Left Ventricular Mass and Function in Children With Growth Hormone Deficiency After Replacement Treatment. Front Pediatr 2018; 6:174. [PMID: 29971224 PMCID: PMC6018080 DOI: 10.3389/fped.2018.00174] [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: 01/12/2018] [Accepted: 05/29/2018] [Indexed: 11/17/2022] Open
Abstract
Background: Our study was designed to assess the effects of GHD on nutritional and metabolic parameters, brain natriuretic peptide (BNP) levels, and left ventricular mass (LVM) in prepubertal children and after short-term GH replacement therapy. Materials and Methods: This prospective study enrolled 81 children. We compared 40 GHD children (16 males and 24 females) to 41 healthy children (control group) (18 males and 23 females). All subjects were at Tanner Stage I (aged 7-11 years). At the baseline, a blood sample was drawn and echocardiographic images were obtained. These tests were repeated on the GHD subjects after 6 months of GH replacement therapy. Body surface, weight, size, blood pressure, heart rate, glucose, insulin, HOMA-IR, HOMA-β, QUICKI, cholesterol, HDLc, LDLc, triglycerides, IGF1, and IGFBP3 were measured. Indexed LVM, diastolic and systolic diameter (dD-sD), diastolic and systolic LV function, isovolumic relaxation time, right ventricle function, and BNP levels were obtained through echocardiography. These parameters were correlated to growth factors. Data were analyzed using Student's t-test or U-Mann-Whitney-test and Pearson's correlation, considering p < 0.05 to be significant. Results: Indexed LVM was smaller in GHD patients than in controls, whereas diastolic and systolic functions, BNP, metabolic, and nutritional profiles were similar. After treatment, nutritional and metabolic profiles significantly improved, though diastolic and systolic functions did not seem to have changed. There was a significant increase in LVM. Indexed LVM was similar to that of controls. Significant correlations were obtained between LVM-IGF1 and sD-IGFBP3. Conclusions: GHD in childhood is associated with a lower indexed LVM. In the short-term, GH increases the indexed LVM, while maintaining normal systolic and diastolic functions, BNP, and an improved lipid profile.
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Affiliation(s)
- E Gómez-Guzmán
- Cardiology Unit, Hospital Reina Sofía de Córdoba, Cordova, Spain.,Instituto Maimonides de Investigación Biomédica de Cordoba, Cordova, Spain
| | - M D Cañete
- Instituto Maimonides de Investigación Biomédica de Cordoba, Cordova, Spain
| | | | - R Cañete
- Cardiology Unit, Hospital Reina Sofía de Córdoba, Cordova, Spain.,Instituto Maimonides de Investigación Biomédica de Cordoba, Cordova, Spain
| | - M Valle
- Instituto Maimonides de Investigación Biomédica de Cordoba, Cordova, Spain.,Clinical Analysis Services, Hospital Valle De Los Pedroches, Cordova, Spain
| | - L Jiménez-Reina
- Instituto Maimonides de Investigación Biomédica de Cordoba, Cordova, Spain.,Facultad de Medicina y Enfermería, Universidad de Córdoba, Cordova, Spain
| | - J Caballero-Villarraso
- Instituto Maimonides de Investigación Biomédica de Cordoba, Cordova, Spain.,Clinical Analysis Services, Hospital Valle De Los Pedroches, Cordova, Spain
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Ciresi A, Radellini S, Guarnotta V, Giordano C. The visceral adiposity index is associated with insulin sensitivity and IGF-I levels in adults with growth hormone deficiency. Endocrine 2017; 56:579-588. [PMID: 27520559 DOI: 10.1007/s12020-016-1076-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 07/31/2016] [Indexed: 01/09/2023]
Abstract
The visceral adiposity index, based on anthropometric and metabolic parameters, has been shown to be related to adipose tissue function and insulin sensitivity. We aimed to evaluate the performance of the visceral adiposity index in adult patients with growth hormone deficiency. We enrolled 52 patients(mean age 51 ± 13 years) with newly diagnosed growth hormone deficiency and 50 matched healthy subjects as controls at baseline. At baseline and after 12 and 24 months of treatment we evaluated anthropometric measures, lipid profile, glucose and insulin during an oral glucose tolerance test, hemoglobin A1c, homeostasis model assessment estimate of insulin resistance, quantitative insulin sensitivity check index, insulin sensitivity index Matsuda, insulin-like growth factor-I and visceral adiposity index. At baseline growth hormone deficiency patients showed higher waist circumference (p < 0.001), low-density lipoprotein cholesterol (p < 0.001) and visceral adiposity index (p = 0.003) with lower insulin sensitivity index (p = 0.007) and high-density lipoprotein cholesterol (p = 0.001) than controls. During growth hormone treatment we observed a significant increase in insulin-like growth factor-I (p < 0.001), high-density lipoprotein (p < 0.001) with a trend toward increase in insulin sensitivity index (p = 0.055) and a significant decrease in total cholesterol (p < 0.001) and visceral adiposity index (p < 0.001), while no significant changes were observed in other clinical and metabolic parameters. The visceral adiposity index was the only parameter that significantly correlated with growth hormone peak at diagnosis (p < 0.001) and with insulin-like growth factor-I and insulin sensitivity index both at diagnosis (p = 0.009 and p < 0.001) and after 12 (p = 0.026 and p = 0.001) and 24 months (p < 0.001 and p = 0.001) of treatment. The visceral adiposity index, which has shown to be associated with both insulin-like growth factor-I and insulin sensitivity, proved to be the most reliable index of metabolic perturbation, among the most common indexes of adiposity assessment and a marker of benefit during treatment in adult growth hormone deficiency patients.
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Affiliation(s)
- Alessandro Ciresi
- Section of Cardio-Respiratory and Endocrine-Metabolic Diseases, Biomedical Department of Internal and Specialist Medicine (DIBIMIS), University of Palermo, Piazza delle Cliniche 2, Palermo, 90127, Italy
| | - Stefano Radellini
- Section of Cardio-Respiratory and Endocrine-Metabolic Diseases, Biomedical Department of Internal and Specialist Medicine (DIBIMIS), University of Palermo, Piazza delle Cliniche 2, Palermo, 90127, Italy
| | - Valentina Guarnotta
- Section of Cardio-Respiratory and Endocrine-Metabolic Diseases, Biomedical Department of Internal and Specialist Medicine (DIBIMIS), University of Palermo, Piazza delle Cliniche 2, Palermo, 90127, Italy
| | - Carla Giordano
- Section of Cardio-Respiratory and Endocrine-Metabolic Diseases, Biomedical Department of Internal and Specialist Medicine (DIBIMIS), University of Palermo, Piazza delle Cliniche 2, Palermo, 90127, Italy.
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32
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Fantini C, Sgrò P, Pittaluga M, de Perini A, Dimauro I, Sartorio A, Caporossi D, Di Luigi L. Short-term, supra-physiological rhGH administration induces transient DNA damage in peripheral lymphocytes of healthy women. J Endocrinol Invest 2017; 40:645-652. [PMID: 28211028 DOI: 10.1007/s40618-016-0603-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 12/21/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE While a good safety for recombinant human growth hormone (rhGH) therapy at replacement doses is recognized, a possible link between high concentration of the GH-IGF-I axis hormones and side negative effect has been reported. The aim of this pilot study was to assess whether a short-term exposure to supra-physiological doses of rhGH may affect DNA integrity in human lymphocytes (PBL). METHODS Eighteen healthy Caucasian female (24.2 ± 3.5 years) were randomly included in a Control (n = 9) and rhGH administration group (n = 9, 3-week treatment). DNA damage (comet assay), chromosomal breaks, and mitotic index in phytohemagglutinin-stimulated PBL were evaluated before (PRE), immediately (POST), and 30 days (POST30) after the last rhGH administration (0.029 mg kg- 1 BW; 6 days/week), together with serum IGF-1 and IGFBP-3 concentrations. RESULTS rhGH administration increased IGF-I, without evidence of persisting IGF-I and IGFBP-3 changes 30 days after withdrawal. Total DNA breakage (% DNA in tails) was not significantly different in subjects treated with rhGH in comparison with controls, although the rhGH-treated subjects showed an higher percentage of heavily damaged nuclei immediately after the treatment (POST30 vs. PRE: p = 0.003), with a lower mitogenic potential of lymphocytes, detectable up to the POST30 (PRE vs. POST: p = 0.02; PRE vs. POST30: p = 0.007). CONCLUSIONS This pilot study showed that 3 weeks of short-term supra-physiological rhGH administration in healthy women induce a transient DNA damage and mitogenic impairment in PBL. The analysis of DNA damage should be explored as useful tool in monitoring the mid to long-term effects of high rhGH treatment or abuse.
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Affiliation(s)
- C Fantini
- Unit of Biology, Department of Movement, Human and Health Sciences, Università di Roma "Foro Italico", Piazza Lauro de Bosis, 15, 00135, Rome, Italy
| | - P Sgrò
- Unit of Endocrinology, Department of Movement, Human and Health Sciences, Università di Roma "Foro Italico", 00135, Rome, Italy
| | - M Pittaluga
- Unit of Biology, Department of Movement, Human and Health Sciences, Università di Roma "Foro Italico", Piazza Lauro de Bosis, 15, 00135, Rome, Italy
| | - A de Perini
- Unit of Biology, Department of Movement, Human and Health Sciences, Università di Roma "Foro Italico", Piazza Lauro de Bosis, 15, 00135, Rome, Italy
| | - I Dimauro
- Unit of Biology, Department of Movement, Human and Health Sciences, Università di Roma "Foro Italico", Piazza Lauro de Bosis, 15, 00135, Rome, Italy
| | - A Sartorio
- Istituto Auxologico Italiano, IRCCS, Experimental Laboratory for Auxo-endocrinological Research, 20145, Milan, Italy
| | - D Caporossi
- Unit of Biology, Department of Movement, Human and Health Sciences, Università di Roma "Foro Italico", Piazza Lauro de Bosis, 15, 00135, Rome, Italy.
| | - L Di Luigi
- Unit of Endocrinology, Department of Movement, Human and Health Sciences, Università di Roma "Foro Italico", 00135, Rome, Italy
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Olsson DS, Bengtsson BÅ. Hypopituitarism-needs modern individualized treatment. Endocrine 2017; 56:1-3. [PMID: 28004235 DOI: 10.1007/s12020-016-1211-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 12/10/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Daniel S Olsson
- Department of Endocrinology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gröna Stråket 8, SE-413 45, Gothenburg, Sweden
| | - Bengt-Åke Bengtsson
- Department of Endocrinology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gröna Stråket 8, SE-413 45, Gothenburg, Sweden.
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Elbornsson M, Horvath A, Götherström G, Bengtsson BÅ, Johannsson G, Svensson J. Seven years of growth hormone (GH) replacement improves quality of life in hypopituitary patients with adult-onset GH deficiency. Eur J Endocrinol 2017; 176:99-109. [PMID: 27803031 DOI: 10.1530/eje-16-0875] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 11/01/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Few studies have determined the effects of long-term growth hormone (GH) replacement on quality of life (QoL). This study investigated the effects of 7 years of GH replacement on QoL. DESIGN A prospective, single-center, open-label study of 95 adults (mean age 52.8 years; 46 men) with adult-onset GH deficiency (GHD). METHODS QoL was measured using Quality of Life-Assessment for Growth Hormone Deficiency in Adults (QoL-AGHDA) and Psychological General Well-Being (PGWB) scores. RESULTS The GH dose was gradually increased from 0.13 mg/day to 0.42 mg/day. IGF-I SD score increased from -1.49 at baseline to 0.35 at study end. The GH replacement induced sustained improvements in total QoL-AGHDA and PGWB scores. GHD women had a more marked improvement in total QoL-AGHDA score than GHD men after 5 and 7 years. Most of the improvement in QoL was seen during the first year, but there was a small further improvement also after one year as measured using QoL-AGHDA. All QoL-AGHDA dimensions improved, but the improvement in memory and concentration as well as tenseness occurred later than that of other dimensions. Correlation analysis demonstrated that the patients with the lowest baseline QoL had the greatest improvement in QoL. CONCLUSIONS Seven years of GH replacement improved QoL with the most marked improvements in GHD women and in patients with low baseline QoL. Most, but not all, of the improvement in QoL was seen during the first year. Some QoL-AGHDA dimensions (memory and concentration, tenseness) responded at a slower rate than other dimensions.
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Affiliation(s)
- Mariam Elbornsson
- Department of EndocrinologyInstitute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Alexandra Horvath
- Department of EndocrinologyInstitute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Galina Götherström
- Department of EndocrinologyInstitute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Bengt-Åke Bengtsson
- Department of EndocrinologyInstitute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Gudmundur Johannsson
- Department of EndocrinologyInstitute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Johan Svensson
- Department of EndocrinologyInstitute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
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Olsson DS, Trimpou P, Hallén T, Bryngelsson IL, Andersson E, Skoglund T, Bengtsson BÅ, Johannsson G, Nilsson AG. Life expectancy in patients with pituitary adenoma receiving growth hormone replacement. Eur J Endocrinol 2017; 176:67-75. [PMID: 27770012 DOI: 10.1530/eje-16-0450] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 10/14/2016] [Accepted: 10/21/2016] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Hypopituitarism has been associated with increased mortality. The excess mortality may be due to untreated growth hormone (GH) deficiency but also due to various underlying disorders. We therefore analysed mortality in patients with only one underlying disorder, non-functioning pituitary adenoma (NFPA), with and without GH replacement therapy (GHRT). DESIGN AND METHOD Patients with NFPA in the western region of Sweden, 1997-2011, were identified through the National Patient Registry and cross-referenced with several National Health Registries. All patient records were reviewed. Standardised mortality ratios (SMRs) with 95% confidence intervals (CIs) were calculated using the general population as reference. Cox-regression models were performed to identify predictors of mortality. RESULTS A total of 426 NFPA patients with 4599 patient-years were included, of whom 207 had used GHRT and 219 had not received GHRT. Median (range) follow-up in patients with and without GHRT was 12.2 (0-25) and 8.2 (0-27) years, respectively. Other pituitary hormone deficiencies were more frequent in the GHRT group than those in the non-GHRT group. SMR was 0.65 (95% CI, 0.44-0.94; P = 0.018) for the GHRT group and 1.16 (0.94-1.42; P = 0.17) for the non-GHRT group. Direct comparison between the groups showed reduced mortality among those who were GH replaced (P = 0.0063). The SMR for malignant tumours was reduced in the GHRT-group (0.29; 0.08-0.73; P = 0.004) but not in untreated patients. CONCLUSIONS Selection bias explaining some of the results cannot be excluded. However, NFPA patients with GHRT had reduced overall mortality compared with the general population, and death due to malignancy was not increased. This suggests that long-term GHRT is safe in adult patients selected for treatment.
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Affiliation(s)
- Daniel S Olsson
- Department of EndocrinologyInstitute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Göteborg, Sweden
| | - Penelope Trimpou
- Department of EndocrinologyInstitute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Göteborg, Sweden
| | - Tobias Hallén
- Department of NeurosurgerySahlgrenska University Hospital, Göteborg, Sweden
| | - Ing-Liss Bryngelsson
- Department of Occupational and Environmental MedicineÖrebro University Hospital, Örebro, Sweden
| | - Eva Andersson
- Department of Occupational and Environmental MedicineSahlgrenska University Hospital, Göteborg, Sweden
| | - Thomas Skoglund
- Department of NeurosurgerySahlgrenska University Hospital, Göteborg, Sweden
| | - Bengt-Åke Bengtsson
- Department of EndocrinologyInstitute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Göteborg, Sweden
| | - Gudmundur Johannsson
- Department of EndocrinologyInstitute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Göteborg, Sweden
| | - Anna G Nilsson
- Department of EndocrinologyInstitute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Göteborg, Sweden
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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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Hujoel P, Bollen AM, Yuen K, Hujoel I. Phenotypic characteristics of adolescents with concave and convex facial profiles – The National Health Examination Survey. HOMO-JOURNAL OF COMPARATIVE HUMAN BIOLOGY 2016; 67:417-432. [DOI: 10.1016/j.jchb.2016.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 04/08/2016] [Indexed: 01/10/2023]
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Meienberg F, Yee M, Johnston D, Cox J, Robinson S, Bell JD, Thomas EL, Taylor-Robinson SD, Godsland I. Liver fat in adults with GH deficiency: comparison to matched controls and the effect of GH replacement. Clin Endocrinol (Oxf) 2016; 85:76-84. [PMID: 26895949 DOI: 10.1111/cen.13042] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 01/04/2016] [Accepted: 02/14/2016] [Indexed: 12/11/2022]
Abstract
CONTEXT Existing data regarding the association between growth hormone deficiency (GHD) and liver fat content are conflicting. OBJECTIVE We aimed (i) to assess intrahepatocellular lipid (IHCL) content in hypopituitary adults with GHD compared to matched controls and (ii) to evaluate the effect of growth hormone (GH) replacement on IHCL content. DESIGN Cross-sectional comparison and controlled intervention study. PATIENTS, PARTICIPANTS Cross-sectional comparison: Twenty-two hypopituitary adults with GHD and 44 healthy controls matched for age, BMI, gender and ethnicity. Intervention study: nine GHD patients starting GH replacement (GH Rx group) and nine GHD patients not starting replacement therapy (non-GH Rx group). INTERVENTION Intervention study: GH replacement for 6 months in the GH Rx group, dosage was titrated to achieve normal IGF-1 levels. MAIN OUTCOME MEASURES HCL content determined by proton magnetic resonance spectroscopy ((1) H MRS). RESULTS Cross-sectional Comparison: There was no difference in IHCL content between GHD patients and healthy controls (1·89% (0·30, 4·03) vs 1·14% (0·22, 2·32); P = 0·2), and the prevalence of patients with hepatic steatosis (IHCL of ≥ 5·56%) was similar in the two groups (22·7% vs 15·9%; chi-square probability = 0·4). Intervention study: The change in IHCL content over 6 months did not differ between the GH Rx group and the non-GH Rx group (-0·63 ± 4·53% vs + 0·11 ± 1·46%; P = 0·6). CONCLUSIONS In our study, liver fat content and the prevalence of hepatic steatosis did not differ between hypopituitary adults with GHD and matched controls. In GHD patients, GH replacement had no effect on liver fat content.
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Affiliation(s)
- Fabian Meienberg
- Department of Endocrinology, Diabetes and Metabolism, University Hospital Basel, Basel, Switzerland
| | - Michael Yee
- Metabolic Medicine Unit, St Mary's Hospital, London, UK
| | - Desmond Johnston
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Jeremy Cox
- Metabolic Medicine Unit, St Mary's Hospital, London, UK
| | | | - Jimmy D Bell
- Department of Life Sciences, Faculty of Science and Technology, University of Westminster, London, UK
| | - E Louise Thomas
- Department of Life Sciences, Faculty of Science and Technology, University of Westminster, London, UK
| | - Simon D Taylor-Robinson
- Hepatology, Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Ian Godsland
- Division of Diabetes Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
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Allo Miguel G, Serraclara Plá A, Partida Muñoz ML, Martínez Díaz-Guerra G, Hawkins F. Seven years of follow up of trabecular bone score, bone mineral density, body composition and quality of life in adults with growth hormone deficiency treated with rhGH replacement in a single center. Ther Adv Endocrinol Metab 2016; 7:93-100. [PMID: 27293538 PMCID: PMC4892402 DOI: 10.1177/2042018816643908] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Adult growth hormone deficiency (AGHD) is characterized by impaired physical activity, diminished quality of life (QoL), weight and fat mass gain, decreased muscle mass and decreased bone mineral density (BMD). The aim of this study was to evaluate the effects of long-term treatment (7 years) with recombinant human growth hormone (rhGH) on metabolic parameters, body composition (BC), BMD, bone microarchitecture and QoL. PATIENTS AND METHODS In this prospective study, BMD and BC were assessed by dual-energy X-ray absorptiometry (DXA). Bone microarchitecture was assessed with the trabecular bone score (TBS). The QoL-AGHDA test was used to assess QoL. RESULTS A total of 18 AGHD patients (mean age, 37.39 ± 12.42) were included. Body weight and body mass index (BMI) showed a significant increase after 7 years (p = 0.03 and p = 0.001, respectively). There was a significant tendency of body fat mass (BFM) (p = 0.028) and lean body mass (LBM) (p = 0.005) to increase during the 7 years of rhGH treatment. There was a significant increase in lumbar spine (LS) BMD (p = 0.01). TBS showed a nonsignificant decrease after 7 years of treatment, with a change of -0.86% ± 1.95. QoL showed a large and significant improvement (p = 0.02). CONCLUSION Long-term rhGH treatment in AGHD patients induces a large and sustained improvement in QoL. Metabolic effects are variable with an increase in LBM as well as in BMI and BFM. There is a positive effect on BMD based on the increase in LS BMD, which stabilizes during long-term therapy and is not associated with a similar increase in bone microarchitecture.
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Affiliation(s)
| | - Alicia Serraclara Plá
- Endocrinology Service, 12 de Octubre University Hospital, University Complutense, Madrid, Spain
| | | | | | - Federico Hawkins
- Endocrinology Service, 12 de Octubre University Hospital, University Complutense, Madrid, Spain
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Rasmussen MH, Janukonyté J, Klose M, Marina D, Tanvig M, Nielsen LF, Höybye C, Andersen M, Feldt-Rasmussen U, Christiansen JS. Reversible Albumin-Binding GH Possesses a Potential Once-Weekly Treatment Profile in Adult Growth Hormone Deficiency. J Clin Endocrinol Metab 2016; 101:988-98. [PMID: 26727076 PMCID: PMC4803179 DOI: 10.1210/jc.2015-1991] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT NNC0195-0092 is a reversible, albumin-binding GH derivative, developed for once-weekly administration. OBJECTIVES The objective of the study was to evaluate safety, local tolerability, pharmacodynamics, and pharmacokinetics of multiple, once-weekly doses of NNC0195-0092, compared with daily GH. DESIGN AND SETTING This was a phase 1, randomized, open-label, active-controlled, multiple-dose, dose-escalation trial. PATIENTS Thirty-four GH-treated adult subjects (male, n = 25) with GH deficiency participated in the study. INTERVENTIONS AND MAIN OUTCOME MEASURES Subjects were sequentially assigned into four cohorts of eight subjects, randomized within each cohort (3:1) to once-weekly NNC0195-0092 (n = 6) for 4 weeks (0.02, 0.04, 0.08, and 0.12 mg/kg) or daily injections of Norditropin NordiFlex (n = 2) for 4 weeks with a dose replicating the pretrial dose of somatropin. A safety assessment was performed prior to initiating treatment at the next dose level of NNC0195-0092. Daily GH treatment was discontinued 14 days before the trial start. Blood samples were drawn for assessment of safety, pharmacokinetics, pharmacodynamics (IGF-1 and IGF-binding protein-3) profiles, and immunogenicity studies. RESULTS Numbers of adverse events were similar at the dose levels of 0.02, 0.04, and 0.08 mg/kg NNC0195-0092 vs daily injections of Norditropin NordiFlex, whereas the number of adverse events was greater at the highest dose level of NNC0195-0092 (0.12 mg/kg). NNC0195-0092 (area under the curve[0-168h]) and peak plasma concentration) increased in a dose-dependent manner, and a dose-dependent increase in IGF-1 levels was observed. IGF-1 profiles were elevated for at least 1 week, and for the 0.02-mg/kg and 0.04-mg/kg NNC0195-0092 doses, the observed IGF-1 levels were similar to the levels for the active control group. CONCLUSION Four once-weekly doses of NNC0195-0092 (dose range 0.02-0.12 mg/kg) administered to adult patients with GH deficiency were well tolerated, and IGF-1 profiles were consistent with a once-weekly treatment profile. No clinically significant safety and tolerability signals causally related to NNC0195-0092 were identified, nor were any immunogenicity concerns revealed.
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Affiliation(s)
- Michael Højby Rasmussen
- Department of Global Development (M.H.R., L.F.N.), Novo Nordisk, DK-2860 Søborg Denmark; Medical Department of Diabetes and Endocrinology, Aarhus University Hospital (J.J., J.S.C.), DK-8000 C Aarhus, Denmark; Department of Endocrinology, Rigshospitalet, (M.K., D.M., U.F.-R.), University of Copenhagen, DK-2100 Copenhagen, Denmark; Department of Endocrinology, Odense University Hospital (M.T., M.A.), DK-5000 Odense, Denmark; and Department of Endocrinology, Karolinska University Hospital (C.H.), SE-171 76 Stockholm, Sweden
| | - Jurgita Janukonyté
- Department of Global Development (M.H.R., L.F.N.), Novo Nordisk, DK-2860 Søborg Denmark; Medical Department of Diabetes and Endocrinology, Aarhus University Hospital (J.J., J.S.C.), DK-8000 C Aarhus, Denmark; Department of Endocrinology, Rigshospitalet, (M.K., D.M., U.F.-R.), University of Copenhagen, DK-2100 Copenhagen, Denmark; Department of Endocrinology, Odense University Hospital (M.T., M.A.), DK-5000 Odense, Denmark; and Department of Endocrinology, Karolinska University Hospital (C.H.), SE-171 76 Stockholm, Sweden
| | - Marianne Klose
- Department of Global Development (M.H.R., L.F.N.), Novo Nordisk, DK-2860 Søborg Denmark; Medical Department of Diabetes and Endocrinology, Aarhus University Hospital (J.J., J.S.C.), DK-8000 C Aarhus, Denmark; Department of Endocrinology, Rigshospitalet, (M.K., D.M., U.F.-R.), University of Copenhagen, DK-2100 Copenhagen, Denmark; Department of Endocrinology, Odense University Hospital (M.T., M.A.), DK-5000 Odense, Denmark; and Department of Endocrinology, Karolinska University Hospital (C.H.), SE-171 76 Stockholm, Sweden
| | - Djordje Marina
- Department of Global Development (M.H.R., L.F.N.), Novo Nordisk, DK-2860 Søborg Denmark; Medical Department of Diabetes and Endocrinology, Aarhus University Hospital (J.J., J.S.C.), DK-8000 C Aarhus, Denmark; Department of Endocrinology, Rigshospitalet, (M.K., D.M., U.F.-R.), University of Copenhagen, DK-2100 Copenhagen, Denmark; Department of Endocrinology, Odense University Hospital (M.T., M.A.), DK-5000 Odense, Denmark; and Department of Endocrinology, Karolinska University Hospital (C.H.), SE-171 76 Stockholm, Sweden
| | - Mette Tanvig
- Department of Global Development (M.H.R., L.F.N.), Novo Nordisk, DK-2860 Søborg Denmark; Medical Department of Diabetes and Endocrinology, Aarhus University Hospital (J.J., J.S.C.), DK-8000 C Aarhus, Denmark; Department of Endocrinology, Rigshospitalet, (M.K., D.M., U.F.-R.), University of Copenhagen, DK-2100 Copenhagen, Denmark; Department of Endocrinology, Odense University Hospital (M.T., M.A.), DK-5000 Odense, Denmark; and Department of Endocrinology, Karolinska University Hospital (C.H.), SE-171 76 Stockholm, Sweden
| | - Lene F Nielsen
- Department of Global Development (M.H.R., L.F.N.), Novo Nordisk, DK-2860 Søborg Denmark; Medical Department of Diabetes and Endocrinology, Aarhus University Hospital (J.J., J.S.C.), DK-8000 C Aarhus, Denmark; Department of Endocrinology, Rigshospitalet, (M.K., D.M., U.F.-R.), University of Copenhagen, DK-2100 Copenhagen, Denmark; Department of Endocrinology, Odense University Hospital (M.T., M.A.), DK-5000 Odense, Denmark; and Department of Endocrinology, Karolinska University Hospital (C.H.), SE-171 76 Stockholm, Sweden
| | - Charlotte Höybye
- Department of Global Development (M.H.R., L.F.N.), Novo Nordisk, DK-2860 Søborg Denmark; Medical Department of Diabetes and Endocrinology, Aarhus University Hospital (J.J., J.S.C.), DK-8000 C Aarhus, Denmark; Department of Endocrinology, Rigshospitalet, (M.K., D.M., U.F.-R.), University of Copenhagen, DK-2100 Copenhagen, Denmark; Department of Endocrinology, Odense University Hospital (M.T., M.A.), DK-5000 Odense, Denmark; and Department of Endocrinology, Karolinska University Hospital (C.H.), SE-171 76 Stockholm, Sweden
| | - Marianne Andersen
- Department of Global Development (M.H.R., L.F.N.), Novo Nordisk, DK-2860 Søborg Denmark; Medical Department of Diabetes and Endocrinology, Aarhus University Hospital (J.J., J.S.C.), DK-8000 C Aarhus, Denmark; Department of Endocrinology, Rigshospitalet, (M.K., D.M., U.F.-R.), University of Copenhagen, DK-2100 Copenhagen, Denmark; Department of Endocrinology, Odense University Hospital (M.T., M.A.), DK-5000 Odense, Denmark; and Department of Endocrinology, Karolinska University Hospital (C.H.), SE-171 76 Stockholm, Sweden
| | - Ulla Feldt-Rasmussen
- Department of Global Development (M.H.R., L.F.N.), Novo Nordisk, DK-2860 Søborg Denmark; Medical Department of Diabetes and Endocrinology, Aarhus University Hospital (J.J., J.S.C.), DK-8000 C Aarhus, Denmark; Department of Endocrinology, Rigshospitalet, (M.K., D.M., U.F.-R.), University of Copenhagen, DK-2100 Copenhagen, Denmark; Department of Endocrinology, Odense University Hospital (M.T., M.A.), DK-5000 Odense, Denmark; and Department of Endocrinology, Karolinska University Hospital (C.H.), SE-171 76 Stockholm, Sweden
| | - Jens Sandahl Christiansen
- Department of Global Development (M.H.R., L.F.N.), Novo Nordisk, DK-2860 Søborg Denmark; Medical Department of Diabetes and Endocrinology, Aarhus University Hospital (J.J., J.S.C.), DK-8000 C Aarhus, Denmark; Department of Endocrinology, Rigshospitalet, (M.K., D.M., U.F.-R.), University of Copenhagen, DK-2100 Copenhagen, Denmark; Department of Endocrinology, Odense University Hospital (M.T., M.A.), DK-5000 Odense, Denmark; and Department of Endocrinology, Karolinska University Hospital (C.H.), SE-171 76 Stockholm, Sweden
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Roelfsema F, Veldhuis JD. Growth Hormone Dynamics in Healthy Adults Are Related to Age and Sex and Strongly Dependent on Body Mass Index. Neuroendocrinology 2016; 103:335-44. [PMID: 26228064 PMCID: PMC4731317 DOI: 10.1159/000438904] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Accepted: 07/15/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Studies on 24-hour growth hormone (GH) secretion are rare. The influences of sex, age, and adiposity are well recognized but generally derived from specific, selected subject groups, not spanning sexes, many age decades, and a range of body weights. OBJECTIVE Our goal was to investigate GH dynamics in a group of 130 healthy adult subjects, both men and women, across 5 age decades as well as a 2.5-fold range of body mass index (BMI) values. METHODS GH was measured by a sensitive immunofluorometric assay. Secretion parameters were quantified by automated deconvolution and relative pattern randomness by approximate entropy (ApEn). RESULTS The median age was 40 years (range 20-77). The median BMI was 26 (range 18.3-49.8). Pulsatile 24-hour GH secretion was negatively correlated with age (p = 0.002) and BMI (p < 0.0001). Basal GH secretion negatively correlated with BMI (p = 0.003) but not with age. The sex- dependent GH secretion (greater in women) was no longer detectable after 50 years of age. Insulin-like growth factor (IGF)-1 levels were lower in women over 50 years of age compared with men of a similar age. ApEn showed an age-related increase in both sexes and was higher in premenopausal and postmenopausal women than in men of comparable age (p < 0.0001). A single fasting GH measurement is not informative of 24-hour GH secretion. CONCLUSIONS BMI dominates the negative regulation of 24-hour GH secretion across 5 decades of age in this up till now largest cohort of healthy adults who underwent 24-hour blood sampling. Sex also impacts GH secretion before the age of 50 years as well as its regularity at all ages. Differences in serum IGF-1 partly depend on the pre- or postmenopausal state. Finally, a single GH measurement is not informative of 24-hour GH secretion.
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Affiliation(s)
- Ferdinand Roelfsema
- Department of Endocrinology and Metabolism, Leiden University Medical Center, Leiden, the Netherlands
| | - Johannes D. Veldhuis
- Endocrine Research Unit, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
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Long-term follow-up results of growth hormone therapy for patients with adult growth hormone deficiency. HORMONES 2016. [DOI: 10.1007/bf03401402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Schneider HJ, Buchfelder M, Wallaschofski H, Luger A, Johannsson G, Kann PH, Mattsson A. Proposal of a clinical response score and predictors of clinical response to 2 years of GH replacement therapy in adult GH deficiency. Eur J Endocrinol 2015; 173:843-51. [PMID: 26369579 DOI: 10.1530/eje-15-0305] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 09/11/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE There is no single clinical marker to reliably assess the clinical response to growth hormone replacement therapy (GHRT) in adults with growth hormone deficiency (GHD). The objective of this study was to propose a clinical response score to GHRT in adult GHD and to establish clinical factors that predict clinical response. DESIGN This was a prospective observational cohort study from the international KIMS database (Pfizer International Metabolic Database). METHODS We included 3612 adult patients with GHD for proposing the response score and 844 patients for assessing predictors of response. We propose a clinical response score based on changes in total cholesterol, waist circumference and QoL-AGHDA quality of life measurements after 2 years of GHRT. A score point was added for each quintile of change in each variable, resulting in a sum score ranging from 3 to 15. For clinical response at 2 years, we analysed predictors at baseline and after 6 months using logistic regression analyses. RESULTS In a baseline prediction model, IGF1, QoL-AGHDA, total cholesterol and waist circumference predicted response, with worse baseline parameters being associated with a favourable response (AUC 0.736). In a combined baseline and 6-month prediction model, baseline QoL-AGHDA, total cholesterol and waist circumference, and 6-month change in waist circumference were significant predictors of response (AUC 0.815). CONCLUSIONS A simple clinical response score might be helpful in evaluating the success of GHRT. The baseline prediction model may aid in the decision to initiate GHRT and the combined prediction model may be helpful in the decision to continue GHRT.
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Affiliation(s)
- Harald J Schneider
- Medizinische Klinik und Poliklinik IVKlinikum der Universität München, Ziemssenstr. 1, 80336 Munich, GermanyKlinik für NeurochirurgieUniversität Erlangen; Erlangen, GermanyInstitut für Klinische Chemie und LabormedizinUniversität Greifswald; Greifswald, GermanyUniversitätsklinik für Innere Medizin IIIMedizinische Universität Wien, Vienna, AustriaDepartment of EndocrinologySahlgrenska Academy, University of Gothenburg and SahlgrenskaUniversity Hospital, Gothenburg, SwedenKlinik für Innere MedizinUniversität Marburg, Marburg, GermanyPfizer Endocrine Care; SollentunaSweden
| | - Michael Buchfelder
- Medizinische Klinik und Poliklinik IVKlinikum der Universität München, Ziemssenstr. 1, 80336 Munich, GermanyKlinik für NeurochirurgieUniversität Erlangen; Erlangen, GermanyInstitut für Klinische Chemie und LabormedizinUniversität Greifswald; Greifswald, GermanyUniversitätsklinik für Innere Medizin IIIMedizinische Universität Wien, Vienna, AustriaDepartment of EndocrinologySahlgrenska Academy, University of Gothenburg and SahlgrenskaUniversity Hospital, Gothenburg, SwedenKlinik für Innere MedizinUniversität Marburg, Marburg, GermanyPfizer Endocrine Care; SollentunaSweden
| | - Henri Wallaschofski
- Medizinische Klinik und Poliklinik IVKlinikum der Universität München, Ziemssenstr. 1, 80336 Munich, GermanyKlinik für NeurochirurgieUniversität Erlangen; Erlangen, GermanyInstitut für Klinische Chemie und LabormedizinUniversität Greifswald; Greifswald, GermanyUniversitätsklinik für Innere Medizin IIIMedizinische Universität Wien, Vienna, AustriaDepartment of EndocrinologySahlgrenska Academy, University of Gothenburg and SahlgrenskaUniversity Hospital, Gothenburg, SwedenKlinik für Innere MedizinUniversität Marburg, Marburg, GermanyPfizer Endocrine Care; SollentunaSweden
| | - Anton Luger
- Medizinische Klinik und Poliklinik IVKlinikum der Universität München, Ziemssenstr. 1, 80336 Munich, GermanyKlinik für NeurochirurgieUniversität Erlangen; Erlangen, GermanyInstitut für Klinische Chemie und LabormedizinUniversität Greifswald; Greifswald, GermanyUniversitätsklinik für Innere Medizin IIIMedizinische Universität Wien, Vienna, AustriaDepartment of EndocrinologySahlgrenska Academy, University of Gothenburg and SahlgrenskaUniversity Hospital, Gothenburg, SwedenKlinik für Innere MedizinUniversität Marburg, Marburg, GermanyPfizer Endocrine Care; SollentunaSweden
| | - Gudmundur Johannsson
- Medizinische Klinik und Poliklinik IVKlinikum der Universität München, Ziemssenstr. 1, 80336 Munich, GermanyKlinik für NeurochirurgieUniversität Erlangen; Erlangen, GermanyInstitut für Klinische Chemie und LabormedizinUniversität Greifswald; Greifswald, GermanyUniversitätsklinik für Innere Medizin IIIMedizinische Universität Wien, Vienna, AustriaDepartment of EndocrinologySahlgrenska Academy, University of Gothenburg and SahlgrenskaUniversity Hospital, Gothenburg, SwedenKlinik für Innere MedizinUniversität Marburg, Marburg, GermanyPfizer Endocrine Care; SollentunaSweden
| | - Peter H Kann
- Medizinische Klinik und Poliklinik IVKlinikum der Universität München, Ziemssenstr. 1, 80336 Munich, GermanyKlinik für NeurochirurgieUniversität Erlangen; Erlangen, GermanyInstitut für Klinische Chemie und LabormedizinUniversität Greifswald; Greifswald, GermanyUniversitätsklinik für Innere Medizin IIIMedizinische Universität Wien, Vienna, AustriaDepartment of EndocrinologySahlgrenska Academy, University of Gothenburg and SahlgrenskaUniversity Hospital, Gothenburg, SwedenKlinik für Innere MedizinUniversität Marburg, Marburg, GermanyPfizer Endocrine Care; SollentunaSweden
| | - Anders Mattsson
- Medizinische Klinik und Poliklinik IVKlinikum der Universität München, Ziemssenstr. 1, 80336 Munich, GermanyKlinik für NeurochirurgieUniversität Erlangen; Erlangen, GermanyInstitut für Klinische Chemie und LabormedizinUniversität Greifswald; Greifswald, GermanyUniversitätsklinik für Innere Medizin IIIMedizinische Universität Wien, Vienna, AustriaDepartment of EndocrinologySahlgrenska Academy, University of Gothenburg and SahlgrenskaUniversity Hospital, Gothenburg, SwedenKlinik für Innere MedizinUniversität Marburg, Marburg, GermanyPfizer Endocrine Care; SollentunaSweden
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Losa M, Beck-Peccoz P, Aimaretti G, Di Somma C, Ambrosio MR, Ferone D, Giampietro A, Corsello SM, Poggi M, Scaroni C, Jia N, Mossetto G, Cannavò S, Rochira V. Characteristics and outcomes of Italian patients from the observational, multicentre, hypopituitary control and complications study (HypoCCS) according to tertiles of growth hormone peak concentration following stimulation testing at study entry. Clin Endocrinol (Oxf) 2015; 83:527-35. [PMID: 26119712 DOI: 10.1111/cen.12839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 12/29/2014] [Accepted: 06/19/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine whether characteristics and outcomes of Italian patients in the observational global Hypopituitary Control and Complication Study (HypoCCS) differed according to the degree of GH deficiency (GHD). DESIGN Patients were grouped by tertiles of stimulated GH peak concentration at baseline (Group A lowest tertile, n = 342; Group B middle tertile, n = 345; Group C highest tertile, n = 338). RESULTS Baseline demographics, lipid levels, body mass index categories and mean Framingham cardiovascular risk indexes were similar in the three groups and remained substantially unchanged over time, with no subsequent significant between-group differences (except mean levels of triglycerides increased in the highest tertile group). GHD was adult-onset for >75% of patients in all groups. The percentage of patients with multiple pituitary deficiencies was higher in Group A than in the other groups; isolated GHD was reported with highest frequency in Group C. Patients in Group A received the lowest mean starting dose of GH. Hyperlipidaemia at baseline was reported in 35·1%, 31·1% and 24·7% of patients in groups A, B and C, respectively (P = 0·029). Mean duration of GH treatment was 7·21, 5·45 and 4·96 years, respectively. The proportion of patients with adverse events did not differ significantly between groups, with a low prevalence over time of diabetes and cancer. CONCLUSIONS In Italian patients from HypoCCS, the level of GH deficit did not influence changes over time in metabolic parameters or adverse event profile, despite differences in GHD severity at baseline and in the starting GH dose.
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Affiliation(s)
- Marco Losa
- IRCCS San Raffaele Hospital, Milan, Italy
| | - Paolo Beck-Peccoz
- Fondazione IRCCS Cà Granda Policlinico, University of Milan, Milan, Italy
| | | | | | | | | | | | | | | | | | - Nan Jia
- Global Statistical Sciences, Eli Lilly and Company, Indianapolis, IN, USA
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Trolle C, Hjerrild B, Mortensen KH, Knorr S, Søndergaard HM, Christiansen JS, Gravholt CH. Low myocardial glucose uptake in Turner syndrome is unaffected by growth hormone: a randomized, placebo-controlled FDG-PET study. Clin Endocrinol (Oxf) 2015; 83:133-40. [PMID: 25645325 DOI: 10.1111/cen.12720] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 12/16/2014] [Accepted: 01/07/2015] [Indexed: 01/15/2023]
Abstract
BACKGROUND An unfavourable cardiovascular and metabolic phenotype causes threefold excess mortality in Turner syndrome (TS), and perturbed cardiac substrate metabolism is increasingly recognized as a common component of cardiovascular and metabolic diseases. We therefore hypothesized that myocardial glucose uptake (MGU) is reduced in TS and that growth hormone (GH) treatment improves MGU. To this end, this controlled trial elucidates MGU in TS and the impact of 6 months of growth hormone treatment on MGU. METHODS AND RESULTS Women with TS (n = 9) were examined at baseline, sequentially treated with either Norditropin(®) SimpleXx or placebo and re-examined after 6 months. MGU and myocardial blood flow (MBF) were measured using 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography (FDG-PET) during a hyperinsulinaemic euglycaemic clamp (at baseline and 6 months). Blood pressure measurement, blood sampling, echocardiography and dual energy X-ray absorptiometry scan were also performed. Age-matched female controls (n = 9) were examined once. Baseline MGU was reduced in TS (0.24 ± 0.08 vs. 0.36 ± 0.13 μmol/g/min in controls; P = 0.036) despite similar insulin sensitivity (whole body glucose uptake (M-value): 9.69 ± 1.86 vs. 9.86 ± 2.58 mg/(min*kg) in controls; P = 0.9). Six months of GH carried no impact on MGU (0.25 ± 0.08 vs. 0.26 ± 0.12 μmol/g/min in the placebo group; P = 0.8). Plasma glucose, low-density cholesterol and triglycerides increased, while M-value and exercise capacity decreased during 6 months of GH treatment. CONCLUSION MGU is reduced in TS despite normal insulin sensitivity. GH treatment does not alter MGU despite decreased whole body insulin sensitivity. A perturbed cardiac glucose uptake appears to be a feature of TS.
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Affiliation(s)
- Christian Trolle
- Department of Endocrinology and Internal Medicine and Medical Research Laboratories, Aarhus University Hospital, Aarhus, Denmark
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Britta Hjerrild
- Department of Endocrinology and Internal Medicine and Medical Research Laboratories, Aarhus University Hospital, Aarhus, Denmark
| | - Kristian Havmand Mortensen
- Department of Endocrinology and Internal Medicine and Medical Research Laboratories, Aarhus University Hospital, Aarhus, Denmark
- University Department of Radiology, Cambridge University Hospitals, Cambridge, UK
| | - Sine Knorr
- Department of Endocrinology and Internal Medicine and Medical Research Laboratories, Aarhus University Hospital, Aarhus, Denmark
| | | | - Jens Sandahl Christiansen
- Department of Endocrinology and Internal Medicine and Medical Research Laboratories, Aarhus University Hospital, Aarhus, Denmark
| | - Claus Højbjerg Gravholt
- Department of Endocrinology and Internal Medicine and Medical Research Laboratories, Aarhus University Hospital, Aarhus, Denmark
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
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46
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Newman CB, Carmichael JD, Kleinberg DL. Effects of low dose versus high dose human growth hormone on body composition and lipids in adults with GH deficiency: a meta-analysis of placebo-controlled randomized trials. Pituitary 2015; 18:297-305. [PMID: 24810900 DOI: 10.1007/s11102-014-0571-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Doses of growth hormone in adults with growth hormone deficiency are now lower than previously. However, it is not clear they are as effective as higher doses. The objective of this meta-analysis was to assess efficacy of low to moderate dose (LD) GH replacement on standard endpoints of GH compared to higher doses. METHODS A meta-analysis was carried out using PubMed, Cochrane and Embase databases from 1960 to 9/23/12. Three reviewers identified randomized double-blind, placebo-controlled trials of 6 months duration. Of 173 publications, 28 representing 22 trials (591 GH-treated patients and 562 placebo) were included. Data were independently extracted by three reviewers. Endpoints were analyzed if ≥4 studies per dose group reported baseline and 6 month data. RESULTS Mean lean body mass (LBM) increased by 2.61 kg in GH-treated subjects versus 0.04 in the placebo group (P < 0.0001). Fat mass (FM) was reduced by -2.19 kg versus 0.31 (GH vs. placebo) (P = 0.0002). Changes in LBM and FM were dose-related (P = 0.02 and 0.007, respectively), high dose (HD) being more effective than low dose (LBM P = 0.03 and FM P = 0.04). In contrast, treatment with GH reduced total cholesterol -0.38 mmol/L versus. 0.01 (placebo) (P < 0.0001), and low density lipoprotein cholesterol (LDL-C) -0.42 mmol/L versus -0.1 (P = 0.0009), but there were no differences between LD and HD GH. CONCLUSIONS LDs of hGH improve total- and LDL-C, and body composition. Higher doses are more effective on body composition, but not lipids.
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Affiliation(s)
- Connie B Newman
- Division of Endocrinology, Department of Medicine, New York University School of Medicine, New York, NY, 10016, USA
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47
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Abstract
This article presents an overview of adult growth hormone deficiency (AGHD) and corticotropin deficiency (central adrenal failure, CAI). Both conditions can result from various ailments affecting the hypothalamus or pituitary gland (most frequently a tumor in the area or its treatment). Clinical manifestations are subtle in AGHD but potentially life-threatening in CAI. The diagnosis needs dynamic testing in most cases. Treatment of AGHD is recommended in patients with documented severe deficiency, and treatment of CAI is mandatory in all cases. Despite significant progress in replacement hormonal therapy, more physiologic treatments and more reliable indicators of treatment adequacy are still needed.
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Affiliation(s)
- Cristina Capatina
- Department of Endocrinology, C.I. Parhon National Institute of Endocrinology, Carol Davila University of Medicine and Pharmacy, 34-36 Aviatorilor Boulevard, Bucharest 011863, Romania; Department of Pituitary and Neuroendocrine Diseases, C.I. Parhon National Institute of Endocrinology, 34-36 Aviatorilor Boulevard, Bucharest 011863, Romania
| | - John A H Wass
- Discipline of Endocrinology and Diabetes, University of Oxford, Old Road, Headington, Oxford OX3 7LE, UK; Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Old Road, Headington, Oxford OX3 7LE, UK.
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48
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Höybye C, Christiansen JS. Growth hormone replacement in adults - current standards and new perspectives. Best Pract Res Clin Endocrinol Metab 2015; 29:115-23. [PMID: 25617177 DOI: 10.1016/j.beem.2014.09.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Growth hormone deficiency (GHD) in adults is an established clinical syndrome characterised by adverse body composition with more body fat than lean body mass, unfavourable blood lipids, decreased physical fitness and poor quality of life. No specific biomarker for GHD exists and the sometimes difficult diagnosis should be made in accordance with, established guidelines. Measurements of insulin-like growth factor I (IGF-I) is often not sufficient for the diagnosis and stimulation tests of the GH reserve are required. After diagnosis of GHD, treatment with GH should be initiated with a low dose, and gradually increased aiming at obtaining an IGF-I level within the upper part of the normal range for age matched healthy controls. Most side effects are mild and transient and attenuated by gradual dose increments. Numerous studies have shown that GH treatment can improve body composition, cardiovascular risk factors, physical capacity and quality of life. However, studies on effects beyond 5 years are few and despite encouraging preliminary reports the ultimate endpoint demonstrating that GH treatment has beneficial effects on mortality, cardiovascular events and fractures without an increase in cancer incidence remain to be solidly demonstrated and studies to resolve these issues are awaited. Trials with long acting GH formulations are ongoing and available data indicate similar effects on outcome measures compared to the effects of daily injections. This review will give an overview of clinically relevant issues of GHD including advice for management of these patients.
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Affiliation(s)
- Charlotte Höybye
- Department of Endocrinology, Metabolism and Diabetology, Karolinska University Hospital, Stockholm, Sweden
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49
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Ren J, Anversa P. The insulin-like growth factor I system: physiological and pathophysiological implication in cardiovascular diseases associated with metabolic syndrome. Biochem Pharmacol 2014; 93:409-17. [PMID: 25541285 DOI: 10.1016/j.bcp.2014.12.006] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 12/11/2014] [Accepted: 12/11/2014] [Indexed: 12/31/2022]
Abstract
Metabolic syndrome is a cluster of risk factors including obesity, dyslipidemia, hypertension, and insulin resistance. A number of theories have been speculated for the pathogenesis of metabolic syndrome including impaired glucose and lipid metabolism, lipotoxicity, oxidative stress, interrupted neurohormonal regulation and compromised intracellular Ca(2+) handling. Recent evidence has revealed that adults with severe growth hormone (GH) and insulin-like growth factor I (IGF-1) deficiency such as Laron syndrome display increased risk of stroke and cardiovascular diseases. IGF-1 signaling may regulate contractility, metabolism, hypertrophy, apoptosis, autophagy, stem cell regeneration and senescence in the heart to maintain cardiac homeostasis. An inverse relationship between plasma IGF-1 levels and prevalence of metabolic syndrome as well as associated cardiovascular complications has been identified, suggesting the clinical promises of IGF-1 analogues or IGF-1 receptor activation in the management of metabolic and cardiovascular diseases. However, the underlying pathophysiological mechanisms between IGF-1 and metabolic syndrome are still poorly understood. This mini-review will discuss the role of IGF-1 signaling cascade in the prevalence of metabolic syndrome in particular the susceptibility to overnutrition and sedentary life style-induced obesity, dyslipidemia, insulin resistance and other features of metabolic syndrome. Special attention will be dedicated in IGF-1-associated changes in cardiac responses in various metabolic syndrome components such as insulin resistance, obesity, hypertension and dyslipidemia. The potential risk of IGF-1 and IGF-1R stimulation such as tumorigenesis is discussed. Therapeutic promises of IGF-1 and IGF-1 analogues including mecasermin, mecasermin rinfabate and PEGylated IGF-1 will be discussed.
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Affiliation(s)
- Jun Ren
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Center for Cardiovascular Research and Alternative Medicine, University of Wyoming College of Health Sciences, Laramie, WY 82071, USA.
| | - Piero Anversa
- Departments of Anesthesia and Medicine and Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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50
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van Bunderen CC, van Varsseveld NC, Heymans MW, Franken AAM, Koppeschaar HPF, van der Lely AJ, Drent ML. Effect of long-term GH replacement therapy on cardiovascular outcomes in GH-deficient patients previously treated for acromegaly: a sub-analysis from the Dutch National Registry of Growth Hormone Treatment in Adults. Eur J Endocrinol 2014; 171:717-26. [PMID: 25227133 DOI: 10.1530/eje-14-0515] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The effect of GH deficiency (GHD) on the metabolic profile of acromegaly patients is unclear in patients previously treated for acromegaly, as are the efficacy and safety of GH treatment in this particular group. The aim of the study is to describe the characteristics of patients with severe GHD who were previously treated for acromegaly, and to investigate the effects of long-term GH treatment on cardiovascular risk factors and morbidity, compared with patients who were treated for a nonfunctioning pituitary adenoma (NFPA). DESIGN A nationwide surveillance study. METHODS Sixty-five patients from the Dutch National Registry of Growth Hormone Treatment in Adults with previous acromegaly were compared with 778 patients with previous NFPA. Cardiovascular indices, including body composition, lipid profile, glucose metabolism, blood pressure, and morbidity were investigated. RESULTS GHD patients with previous acromegaly had an unfavorable metabolic profile comparable with or more than GHD patients with previous NFPA. GH treatment led to improvement of the lipid profile in both groups, also after excluding patients using lipid-lowering medication. In patients with previous acromegaly, HbA1c levels increased more than in patients with previous NFPA (estimate 0.03, 95% CI 0.002-0.06, P=0.04). The risk for developing cardiovascular diseases was not different between the groups. CONCLUSIONS The patients with GHD after previous acromegaly have an unfavorable metabolic profile comparable with patients with GHD after previous NFPA. In both groups, the lipid profile improves during GH treatment. Changes in glucose metabolism should be monitored closely. GH treatment in patients with GHD previously treated for acromegaly had no deleterious effect on cardiovascular morbidity.
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Affiliation(s)
- Christa C van Bunderen
- Section of EndocrinologyDepartment of Internal Medicine, Neuroscience Campus Amsterdam, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The NetherlandsDepartment of Epidemiology and BiostatisticsVU University Medical Center, Amsterdam, The NetherlandsDepartment of Internal MedicineIsala Clinics, Zwolle, The NetherlandsEmotional Brain and Alan Turing Institute for Multidisciplinary Health ResearchAlmere, The NetherlandsDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Nadège C van Varsseveld
- Section of EndocrinologyDepartment of Internal Medicine, Neuroscience Campus Amsterdam, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The NetherlandsDepartment of Epidemiology and BiostatisticsVU University Medical Center, Amsterdam, The NetherlandsDepartment of Internal MedicineIsala Clinics, Zwolle, The NetherlandsEmotional Brain and Alan Turing Institute for Multidisciplinary Health ResearchAlmere, The NetherlandsDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Martijn W Heymans
- Section of EndocrinologyDepartment of Internal Medicine, Neuroscience Campus Amsterdam, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The NetherlandsDepartment of Epidemiology and BiostatisticsVU University Medical Center, Amsterdam, The NetherlandsDepartment of Internal MedicineIsala Clinics, Zwolle, The NetherlandsEmotional Brain and Alan Turing Institute for Multidisciplinary Health ResearchAlmere, The NetherlandsDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Anton A M Franken
- Section of EndocrinologyDepartment of Internal Medicine, Neuroscience Campus Amsterdam, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The NetherlandsDepartment of Epidemiology and BiostatisticsVU University Medical Center, Amsterdam, The NetherlandsDepartment of Internal MedicineIsala Clinics, Zwolle, The NetherlandsEmotional Brain and Alan Turing Institute for Multidisciplinary Health ResearchAlmere, The NetherlandsDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Hans P F Koppeschaar
- Section of EndocrinologyDepartment of Internal Medicine, Neuroscience Campus Amsterdam, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The NetherlandsDepartment of Epidemiology and BiostatisticsVU University Medical Center, Amsterdam, The NetherlandsDepartment of Internal MedicineIsala Clinics, Zwolle, The NetherlandsEmotional Brain and Alan Turing Institute for Multidisciplinary Health ResearchAlmere, The NetherlandsDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Aart J van der Lely
- Section of EndocrinologyDepartment of Internal Medicine, Neuroscience Campus Amsterdam, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The NetherlandsDepartment of Epidemiology and BiostatisticsVU University Medical Center, Amsterdam, The NetherlandsDepartment of Internal MedicineIsala Clinics, Zwolle, The NetherlandsEmotional Brain and Alan Turing Institute for Multidisciplinary Health ResearchAlmere, The NetherlandsDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Madeleine L Drent
- Section of EndocrinologyDepartment of Internal Medicine, Neuroscience Campus Amsterdam, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The NetherlandsDepartment of Epidemiology and BiostatisticsVU University Medical Center, Amsterdam, The NetherlandsDepartment of Internal MedicineIsala Clinics, Zwolle, The NetherlandsEmotional Brain and Alan Turing Institute for Multidisciplinary Health ResearchAlmere, The NetherlandsDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
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