Rosane Resende de Lima Oliveira Brasil

Glucose Metabolism and Visceral Fat in GH Deficient Adults: Two Years of GH-Replacement

The aim of this study was to evaluate the effect of 24 months of growth hormone (GH) replacement on glucose metabolism and visceral fat in 17 adults with GH deficiency: 9 men and 8 women; age 40 ± 1.8 yr. [range 20–61] and body mass index 25 ± 0.8 Kg/m2.Glucose metabolism was evaluated by a standard oral glucose tolerance test (OGTT), by the homeostatic model assessment (HOMA) insulin resistance index and by the insulin sensitivity index (ISI)-composite derived from the OGTT. Visceral fat was evaluated by CT scan.Twenty-four months of GH replacement induced an increase in the prevalence of abnormal glucose tolerance, with significant progressive increment in 2h-OGTT insulin levels at 3, 12 and 24 months (p = 0.005). Plasma glucose levels and ISI-composite did not alter during the study. HOMA-IR index increased only in the group of patients (n = 8) who had abnormal OGTT at 24 months (p = 0.012). Visceral fat reduced at month 12 and remained decreased until the end of the study (p = 0.009).In conclusion, the present study suggests that adults with GH deficiency after twenty-four months of GH replacement developed abnormal glucose tolerance, probably due to an increase in insulin resistance, associated with higher insulin levels, despite favorable alterations in body composition.

Ambulatory monitoring of blood pressure in growth hormone-deficient adults

The aim of this study was to evaluate the 24-h pattern of blood pressure in adults with growth hormone deficiency using ambulatory blood pressure monitoring. We therefore evaluated the mean systolic and diastolic blood pressures, systolic and diastolic blood pressure loads and diurnal blood pressure rhythm. We used an auscultatory-type monitor, the measurements being made at 10–15 min intervals during the day and 20–30 min intervals at night. We included patients with a growth hormone peak of less than 3 ng/ml in at least two stimulation tests: the insulin tolerance and glucagon tests. The exclusion criteria were mental illnesses, pregnancy, diabetes mellitus, blood pressure higher than 160/90 mmHg, the use of growth hormone in the previous 12 months, severe acute illnesses, chronic liver or kidney disease and a history of malignancy. The results were interpreted according to the II Brazilian Consensus for the utilization of ambulatory monitoring. The study population comprised 27 adult patients with growth hormone deficiency, 11 male and 16 female, with an age range of 21–62 years. Five had developed the condition during childhood, whereas the remainder had adult-onset growth hormone deficiency. The mean systolic (115 ± 16.7 mmHg) and diastolic blood pressure loads (75.51 ± 1.90 mmHg) were normal. There was a tendency towards a lower blood pressure in patients with childhood-onset growth hormone deficiency when compared with their adult-onset counterparts. Men had a lower systolic blood pressure than women, the same pattern being found for mean diastolic blood pressure. Multiple regression analysis showed that age was the only independent variable with the statistical power to explain the variance of blood pressure in this group of patients. The incidence of non-dippers was 37.03%. Growth hormone deficiency thus seems to be associated with a change in the 24-h blood pressure pattern, with a high incidence of non-dippers.

Acromegaly and non-Hodgkin's lymphoma.

OBJECTIVE To present the fourth case report of development of a non-Hodgkins lymphoma in a patient with active acromegaly. METHODS We describe the clinical, laboratory, and imaging findings in a patient with untreated acromegaly in whom a large cell non-Hodgkins lymphoma developed. RESULTS Acromegaly is associated with several comorbid conditions. Among these is a higher incidence of several types of visceral malignant lesions, especially carcinoma of the colon. Growth hormone stimulates the hepatic production of somatomedins, such as insulin-like growth factors, which are known promoters of human growth and have also been implicated in tumorigenesis. In recent years, several cases of lymphoproliferative diseases have also been noted in patients with acromegaly. These conditions include multiple myeloma, lymphoma, and leukemia; three previous cases of non-Hodgkins lymphoma have been described. In our patient, a 57-year-old man with acromegaly, magnetic resonance imaging of the pituitary gland disclosed a large intrasellar mass. Large cell non-Hodgkins lymphoma was diagnosed. Six months of chemotherapy yielded complete remission. CONCLUSION An additional case of non-Hodgkins lymphoma in a patient with acromegaly supports the accumulating evidence of an increased risk for development of cancer in such patients.

Comparison of two dose regimens of growth hormone (GH) with different target IGF-1 levels on glucose metabolism, lipid profile, cardiovascular function and anthropometric parameters in gh-deficient adults.

OBJECTIVE To compare the effects of two regimens of GH therapy with different target IGF-1 levels on anthropometric parameters, glucose metabolism, lipid profile and cardiac function in adults with GH deficiency (GHD). PATIENTS AND METHODS Retrospective analysis of 14 GHD adults from Clementino Fraga Filho University Hospital, Rio de Janeiro, Brazil, who were treated with a GH regimen aimed at maintaining serum IGF-1 levels between the median and upper reference limit (high dose group - HDGH) and 18 GHD adults from Federal University Hospital, Curitiba, Brazil, who received a fixed GH dose of 0.2mg/day in the first year of treatment, followed by titration to maintain serum IGF-1 levels between the median and lower reference limit (low dose group - LDGH). All patients were followed for 2 years with analysis of anthropometric parameters, serum levels of IGF-1, glucose, insulin, HOMA-IR, lipid profile, and transthoracic echocardiography. RESULTS Changes on weight, BMI and waist circumference were similar between the two groups. Insulin levels increased and HOMA-IR worsened in the LDGH group at 1year and improved thereafter. Total cholesterol and triglycerides did not change with therapy. LDL cholesterol reduced in both groups, while HDL-cholesterol significantly increased only in the HDGH group (p=0.007 vs LDGH). No significant variations on echocardiographic parameters were observed. CONCLUSION The HDGH and LDGH regimens resulted in similar changes on anthropometric, echocardiographic, glucose and lipid parameters in GHD adults, except for increase in HDL cholesterol that was only observed in the HDGH regimen.

Avaliação do Metabolismo Glicídico e da Gordura Visceral em Adultos Deficientes de Hormônio de Crescimento

Growth hormone deficiency (GHD) syndrome in adults and the resulting increased cardiovascular risk have been extensively studied in recent years. To evaluate body composition abnormalities and insulin resistance in GHD adults, we studied 27 patients using abdominal CT, considering glucose and insulin responses during an oral glucose tolerance test (OGTT) and the Homeostasis Model Assessment (HOMA). The group of patients was compared to a control group of 27 healthy individuals matched by age, gender and body mass index. GHD patients showed increase in the amount of visceral adipose tissue (p= 0.008). The frequency of abnormalities indicated by OGTT was similar to that found within the control group. Fasting and after-oral glucose load plasma glucose and insulin levels were similar to those identified within the control group (p>0.05). The areas under the glucose and insulin curves were also similar (p>0.05) and there were no differences in the insulin sensitivity measured by HOMA (p= 0.989). There was a strong positive correlation between increased visceral adipose tissue with after-oral glucose load plasma glucose (r= 0.58; p= 0.001) and insulin (r= 0.72; p= 0.001) levels and the areas under the glucose (r= 0.40; p= 0.040) and insulin (r= 0.71; p= 0.001) curves on the patient group, but not within the control group (r 0.05). In conclusion, it was not observed any significant difference in glucose metabolism, despite the increased amount of visceral fat found in GHD patients.

Efeitos do treinamento físico contra resistência sobre a composição corporal e a potência muscular em adultos deficientes de hormônio do crescimento

Growth hormone (GH) deficiency syndrome in adults is well established, as well as the benefits of replacement with recombinant GH. Body composition changes are frequently studied in these patients, and are characterized by an increase in total body fat with predominant trunk obesity, a decrease in lean body mass, muscular strength and total body water. All of these features are almost completely reversed after recombinant GH therapy. This study evaluated body composition and muscle power in 11 GH-deficient patients before and after undergoing a resistance-training program for 12 weeks without GH replacement. We evaluated the body composition by measuring girths, skinfolds, weight, height, body mass index, waist-hip ratio and abdominal computerized tomography. Muscle power was assessed in several muscle groups by mean of five exercises in a muscle-training machine, to which a tensiometer was attached. The data analysis showed that there were no changes in body composition, body mass index, waist-hip ratio and weight. When we studied separately the sum of central and peripheral skinfolds, we noted a volume reduction in the sum of central skinfolds. With relation to muscular strength and power there was no gain in handgrip muscular strength (p>0.05), whereas muscular power showed a significant increase after the training (p<0.01). We concluded that when these patients are submitted to a home-based training program of resistance - type exercises they gain muscular power, and that this type of exercise is a therapeutic alternative that can improve their quality of life whenever the use of recombinant GH is not possible.

Perfil lipídico e composição corporal na deficiência do hormônio de crescimento em adultos

BACKGROUND: The growth hormone deficiency (GHD) syndrome in adults and the increased associated cardiovascular risk have been extensively studied in recent years. Abnormal body composition with excess of visceral adiposity and adverse lipid profile are important features of this syndrome. Abnormal lipid profile has been described with increased levels of total cholesterol (C), LDL-cholesterol (LDL-C), triglycerides, decreased levels of HDL-cholesterol (HDL-C) and apolipoproteins abnormalities. METHODS: Lipid profile and the amount of visceral adipose tissue were studied in 31 GHD adults compared with a control group of healthy subjects matched for age, gender and body mass index (BMI). Visceral adipose tissue was evaluated by abdominal computed tomography and anthropometric measurements- BMI (kg/m2) and waist circumference (cm). The lipid profile was studied by measurement of C, LDL-C, HDL-C, triglycerides, apolipoproteins A and B, and Lipoprotein (a). RESULTS: The GHD adults showed increased visceral adipose tissue (156.66 ± 72.72 vs. 113.51 ± 32.97 cm2, p = 0.049), higher levels of triglycerides (158.58 ± 80.29 vs. 97.17 ± 12.37 mg/dl; p = 0.007) and lower HDL- cholesterol (45.41±13.30 vs. 55.34±14.31 mg/dl; p = 0.002). There were no differences in others aspects of lipid profile and anthropometric measurements. CONCLUSION: Growth Hormone Deficient adults showed increased visceral adipose tissue, higher levels of triglycerides and lower HDL- cholesterol levels.