Only a few studies have investigated the effects of GH replacement in adults for more than 5 yr. OBJECTIVE/DESIGN/PATIENTS: In a prospective, open-label, single-center study, the effects of 10-yr GH replacement were determined. Eighty-seven consecutive patients (52 men and 35 women), with a mean age of 44.1 (range 22-74) yr with adult-onset GH deficiency (GHD) were included.
The initial mean dose of GH (0.98 mg/d) was reduced during the study and at yr 10 was 0.47 mg/d. The mean IGF-I sd score increased from -1.81 at baseline to 1.29 at study end. The absolute reduction in total body fat was transient. However, after correction for age and sex using a four-compartment model, the reduction in body fat was sustained during the 10-yr study period. There was a sustained improvement in serum lipid profile and after 10 yr, and blood glycosylated hemoglobin level was reduced. The treatment responses in IGF-I sd score, serum high-density lipoprotein cholesterol level, and body composition as measured using dual-energy x-ray absorptiometry were more marked in men, whereas women had a more marked reduction in blood glycosylated hemoglobin level.
The effect on the absolute amount of body fat was seen early and was transient, which could be due to the normal aging of the patients. The effects on metabolic indices were detected later, but they were sustained and even progressive throughout the study period.
"The GH replacement in older subjects may not only modulate the levels of IGFs and IGFBPs but also with little gender-related differences (i.e., increase of IGF-1 and IGFBP-3 in both sexes; IGFBP-2 and IGFBP-5 increase only in men and immunoreactive insulin increase only in women) (Munzer et al. 2006). However, men may have a better response (IGF-1 levels) to GH replacement than women (Gotherstrom et al. 2007). The replacement can also increase the protein synthesis in elderly people, this effect is stronger in men when GH replacement is carried along with testosterone (Huang et al. 2005). "
[Show abstract][Hide abstract] ABSTRACT: There is evidence suggesting that immunosenescence can be accelerated by external factors such as chronic stress. Here we review potential psychoneuroendocrine determinants of premature aging of the immune system and discuss available interventions aimed at attenuating immunosenescence. Chronic stress may accelerate various features of immunosenescence by activating key allostatic systems, notably the hypothalamic-pituitary-adrenal axis. The immunological impact of such neuroendocrine dysregulation may be further amplified by a dramatic decline in dehydroepiandrosterone (DHEA) levels, acting in part as an endogenous glucocorticoid antagonist. Stress-buffering strategies show beneficial effects on various biomarkers in elderly populations. Likewise, supplementation of DHEA, melatonin or growth hormone has yielded significant beneficial effects in a number of studies, including: increased well-being, memory performance, bone mineral density and improved immunocompetence as evidenced by results of in vitro (T cell proliferation, cytotoxicity, cytokine production), and in vivo immune challenges. However, the side-effects of hormonal supplementation are also discussed. Finally, moderate exercise via the promotion of cortisol/DHEA balance or epigenetic modifications, is associated with lower serum pro-inflammatory cytokines, greater lymphoproliferative responses and lower counts of senescent T cells. Taken together, these data suggest that immune system is plastic and immunosenescence can be attenuated psychoneuroendocrine interventions.
[Show abstract][Hide abstract] ABSTRACT: Growth hormone (GH) is a polypeptide hormone, secreted by somatotropic cells of the anterior part of the hypophysis. Its application in therapy, first limited to GH deficient children, has now been widened to various other clinical conditions, not necessarily related to short stature. Clinical trials conducted in recent years have proved the safety of its administration in both children and adults. The efficacy of this form of therapy varies, according to different authors, from enthusiastic data to very critical opinions. For many pediatric diseases, such as GH deficiency or Turner syndrome, GH is regarded by many experts, despite the high costs of the therapy, as the first-line treatment. Mounting evidence suggests that GH is safe and effective also in children with chronic renal failure and cystic fibrosis. Recently, it has also been administered to adults with GH deficiency and short bowel syndrome. The aim of this paper is to summarize the current data on GH administration in modern pharmacotherapy. In this paper we have included the results of the recently published studies and discussed not commonly known indications for GH therapy, as well as its experimental administration in both children and adults.
[Show abstract][Hide abstract] ABSTRACT: The American Association of Clinical Endocrinologists Medical Guidelines for Growth Hormone use in Growth Hormone Deficient Adults and Transition Patients – 2009 Update are systematically developed statements to assist health care providers in medical decision making for specific clinical conditions. Most of the content herein is based on literature reviews. In areas of uncertainty, professional judgment was applied. These guidelines are a working document that reflects the state of the field at the time of publication. Because rapid changes in this area are expected, periodic revisions are inevitable. We encourage medical professionals to use this information in conjunction with their best clinical judgment. The presented recommendations may not be appropriate in all situations. Any decision by practitioners to apply these guidelines must be made in light of local resources and individual circumstances.
Endocrine Practice 09/2009; 15(6):580-6. DOI:10.4158/EP.15.6.580 · 2.81 Impact Factor
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