A 10-Year, Prospective Study of the Metabolic Effects of Growth Hormone Replacement in Adults
Research Centre for Endocrinology and Metabolism, Department of Clinical Nutrition, Gröna Stråket 8, Sahlgrenska University Hospital, SE-413 45 Göteborg, Sweden. Journal of Clinical Endocrinology & Metabolism
(Impact Factor: 6.21).
05/2007; 92(4):1442-5. DOI: 10.1210/jc.2006-1487
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.
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- "Adrenal insufficiency could also be iatrogenic in origin. Disruption of the HPA axis and growth hormone deficiency in PWS have been well documented with growth hormone therapy now in widespread use[25,26]. The AACE (American Association of Clinical Endocrinologists) guidelines for the use of GH therapy remind clinicians that GH can inhibit the enzyme 11 β-hydroxysteroid dehydrogenase type 1 causing a shift in cortisol metabolism to favour cortisone production and, therefore, reduce global cortisol levels[27,28]. "
Available from: Guilherme Cerutti Müller
- "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). "
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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.
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