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Objective:To explore the effect of adult growth hormone deficiency on cognitive function in adults.Methods:A total of 19 hypophyseal or craniopharyngioma patients who underwent surgical treatment and were diagnosed with adult growth hormone deficiency in Department of Endocrinolog, the Second Affiliated Hospital, School of Medicine, Zhejiang University from June 2017 to June 2018 were selected as the case group, and 19 normal people were included as the control group. All the members were assessed with the cognitive function scale and brain functional magnetic resonance examination, data between the groups were analyzed.Results:The body weight within a year of case group was significantly increased than that of the control group( P=0.017). Compared with the control group, the case group was relatively inattentive and had decreased memory(Time of stroop color words test-a, test-c, and trail-making test-A, P values were 0.009, 0.018, 0.020 respectively; Auditory word learning test N6, P=0.008). The executive function and language ability of the case group were weakened compared with the control group(Raven′s matrices score E1-E12, P=0.022; Time cost and the number of arrivals in 1 min of connection test B, P values were 0.023, 0.004; Symbol digit modalities test, P=0.037; The number of words spoken in 46-60 s and total number in 0-60 s of the case group was less than the control, P values were 0.030, 0.006). The general mental state of the case group was worse than the control group( P=0.018). The accuracy of the 2-back task of the case group was significantly lower and the activation signal of the left frontal lobe in the case group was significantly weaker( P<0.005). Conclusions:Adult growth hormone deficiency may increase obesity risk and have a detrimental influence on patients′ overall mental health, resulting in varying degrees of cognitive impairment. Working memory impairments associated with adult growth hormone deficiency may be a result of decreased frontal lobe brain activity.
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[Abstract] Objective To investigate the significance of Chinese visceral adipose index (CVAI) on predicting insulin resistance (IR) in Chinese adult patients with growth hormone deficiency (AGHD). Methods Seventy-seven AGHD patients, admitted from Jun. 2016 to Jun. 2017 in the First Affiliated Hospital of Chongqing Medical University, and 77 healthy people matched with age and gender were enrolled as the subjects. The cut-off point for judging IR was 2.69 that was at the upper quartile of the homeostasis model assessment of insulin resistance (HAMA-IR) value of 10 147 subjects aged 25-74 with normal glucose tolerance in the National Diabetes Prevention and Treatment Cooperative Group Survey Bank in 1994. Based on the cut-off point, AGHD patients were divided into IR group and insulin sensitivity (IS) group. Based on CVAI quartile, the AGHD patients were divided into 4 groups. The general anthropometric parameters and glycolipid biochemical index were measured, and waist hip index (WHR), body mass index (BMI), HOMA-IR, lipid accumulation product (LAP), visceral adipose index (VAI) and CVAI were calculated. The calculated area under curve (AUC) of receiver operating characteristic (ROC) curve was used to evaluate the significance of BMI, WHR, waist circumference (WC), LAP, VAI and CVAI in the prediction of IR among AGHD patients. Results The levels of BMI, WC, hip circumference (HC), diastolic blood pressure (DBP), fasting insulin (FINS), HOMA-IR, LAP, VAI and CVAI were obviously higher (P<0.05), and of high density lipoprotein cholesterol (HDL-C) was markedly lower (P<0.05) in AGHD group than those in control group. The weight, DBP, fasting plasma glucose (FPG), FINS, HOMA-IR, triglyceride (TG), CVAI, LAP and VAI were significantly higher (P<0.05) and insulin-like growth factor 1 (IGF-1), HDL-C were significantly lower (P<0.05) in IR group than those in IS group. The age, height, weight, BMI, WC, HC, WHR, FINS, HOMA-IR, TG, LAP and VAI were increased (P<0.05) and HDL-C and IGF-1 decreased (P<0.05) along with the CVAI increase. The ROC curve showed the largest area under the CVAI curve (0.899), the optimal critical value of CVAI was 89.26, which showed higher sensitivity and specificity. Conclusion Compared with the other body adipose index, CVAI may be more accurately able to screen and evaluate IR in Chinese patients with AGHD diseases.
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Recombinant human growth hormone(rhGH)treatment can improve serum glycolipid metabolism,body composition and quality of life in adults growth hormone deficiency(AGHD).Individual differences in rhGH dose and rhGH response to treatment between different patients,gene polymorphisms may play an important role.
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Growth hormone is a protein secreted by the anterior pituitary acidophilic cell,which directly or indirectly affects growth and metabolism via insulin-like growth factor.Growth hormone can be applied to the target cells of various tissues,and has extensive physiological functions.With the development of further clinical studies,the application of recombinant human growth hormone is no longer limited to children dwarfism treatment,and it also has clinical significances in the adult growth hormone deficiency,neurological diseases such as hypoxic-ischemic encephalopathy,traumatic brain injuries,cerebral palsy,Alzheimer's disease and other diseases such as bum and assisted reproduction.This paper reviews current clinical application and research progress in recombinant human growth hormone at home and abroad.
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Objective To explore the correlation of visceral adipose index (VAI) with anthropometrics, glycolipid metabolism markers, high-sensitivity C-reactive protein (hs-CRP) and interleukin-6 (IL-6) in patients with adult growth hormone deficiency (AGHD). Methods A total of 40 AGHD patients from First Affiliated Hospital of Chongqing Medical University and 40 healthy adults from physical examination centre (control group), matched with age and gender, were enrolled in present study. The general anthropometrics and blood biochemical indexes were collected and compared between the two groups. Waist circumference (WC), body mass index (BMI), waist-hip ratio (WHR), waist-height ratio (WHtR), and visceral adipose index (VAI) were examined, and homeostasis model assessment-insulin resistance (HOMA-IR), homeostasis model assessment β-cell function (HOMA-β), LDL-C/HDL-C, TC/HDL-C and TG/LDL-C between the two groups were calculated. Results Compared with control group, the levels of BMI, WC, WHR, fasting insulin (FINS), HOMA-β, HOMA-IR, triglyceride (TG), LDL-C/HDL-C, TC/HDL-C, hs-CPR, IL-6 and VAI were significantly higher, but those of HDL-C were lower in AGHD group (P<0.05). There was a positive correlation between VAI and all the factors including WC, WHR, FINS, HOMA-β, HOMA-IR, TC, LDL-C/HDL-C, TC/HDL-C, TG/LDL-C, hs-CRP and IL-6 (P<0.05). Multiple linear regression analysis revealed that hs-CRP and IL-6 were the independent risk factors of VAI. Pearson correlation index analysis showed that VAI was more correlated with lipid metabolism and inflammatory cytokines than with WC, BMI, WHR and WHtR. Conclusion VAI is significantly higher in AGHD patients than in healthy people, and it shows a strong correlation with many risk factors for cardiovascular diseases.
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Objective To investigate the correlation of atherogenic index of plasma (AIP) levels with anthropometrics, glycolipid metabolism markers and high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6) in adult growth hormone deficiency (AGHD) patients. Methods Retrospective analysis were carried out in 40 AGHD patients (AGHD group, admitted to First Affiliated Hospital of Chongqing Medical University) and 40 healthy adults from physical examination centre (control group) during June 2009 to September 2012. The general anthropometries and blood biochemical indexes were collected and compared between two groups. AIP, homeostasis model assessment-insulin resistance (HOMA-IR), homeostasis model assessment β-cell function (HOMA-β), LDL-C/HDL-C, TC/HDL-C, and TG/LDL-C were calculated and compared between two groups. The correlation between AIP and these indexes was analyzed using Pearson correlation. Results Compared with control group, body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), fasting insulin (FINS), HOMA-P, HOMA-IR, total cholesterol (TC), triglyceride (TG), LDL-C/HDL-C, TC/HDL-C, hs-CPR, IL-6, AIP were significant higher, but HDL-C levels were lower in AGHD group (P0.05). There was a positive association between AIP and all the WC, WHR, FINS, HOMA- β, HOMA-IR, TC, \LDL-C/HDL-C, TC/HDL-C, TG/LDL-C, hs-CRP and IL-6 (r=0.349, 0.314, 0.347, 0.335, 0.297, 0.256, 0.576, 0.749, 0.702, 0.477, 0.226, respectively, P<0.05). Multiple linear regression analysis revealed that hs-CRP and IL-6 were independent risk factors of AIP. Conclusion AIP is significantly higher in AGHD patients than healthy people, and it shows a strong correlation with many risk factors for cardiovascular diseases.
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Objective To assess the significance of insulin tolerance test(ITT) in clinical diagnosis of adult growth hormone deficiency(GHD).Methods Eighty-two patients with an established diagnosis of adult GHD [53males,29 females,mean age (30.9 ± 12.3) years (18-65 years)] were reviewed retrospectively for evaluating the GH response to ITT in the General Hospital of the People' s Liberation Army.Control data for peak GH after ITT were obtained in 15 healthy subjects [9 males,6 females,mean age (26.7 ± 5.6) years (22-41 years)].Receiver operating characteristic (ROC) curve analysis and the area under the curve (AUC) were used to evaluate the diagnostic cut-off point of peak GH and GH increment response to ITT.Results (1) Mean peak GH response to ITT was significantly higher in 15 controls compared with 82 patients (the median 14 μg/L vs 0.62 μg/L,P =0.001).The cut-off point of the peak GH(chemiluminescent immunoassay,CLIA) response to ITT in adult GHD was 4.935 μg/L (AUC 0.993).(2) Mean GH increment was significantly higher in 15 controls compared with 82 patients (the median 13.17 μg/L vs 0.19 ug/L,P＜0.001).The cut-off point of the GH increment was 4.088 μg/L(AUC 0.937),with a 91.5％ sensitivity and 100％ specificity.(3) The peak GH showed even higher diagnostic value than the GH increment after ITT.(4)The above mentioned cut-off points (peak GH less than 4.935 μg/L and 5 μg/L) had a coincidence with a 95.1％ sensitivity and 100％ specificity,respectively.Conclusion The current guidelines for the diagnosis of adult GHD based on the optimal cut-off point of the peak GH(CLIA) response to ITT less than 5 μg/L turned to be of reliable diagnostic value in our country.
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Adult growth hormone deficiency (GHD) is associated with increased morbidity and mortality and reduced quality of life. GH status should be reevaluated in the transitional age for continued treatment to complete somatic development. All children diagnosed with GHD should be retested by insulin provocative tests upon completion of skeletal growth. A low insulin-like growth factor (IGF)-I is a reliable diagnostic indicator of GHD in the presence of hypopituitarism, however, a normal IGF-I does not rule out GHD. When the diagnosis of adult GHD is established, continuation of GH therapy is strongly recommended. Continued GH treatment from adolescence into early adulthood may contribute to the attainment of a normal bone and muscle mass and contribute to a decrease of the cardiovascular risk of GHD adults. There is ongoing debate about nearly every aspect of GH therapy.
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Adolescent , Adult , Child , Humans , Growth Hormone , Hypopituitarism , Insulin , Insulin-Like Growth Factor I , Muscles , Quality of LifeABSTRACT
A deficiência de hormônio do crescimento (DGH) na vida adulta (DGHA) é entidade clínica bem estabelecida, com características heterogêneas e na qual as principais etiologias são as neoplasias da região hipotálamo-hipofisária e/ou seus tratamentos. O seu diagnóstico deve ser considerado em indivíduos com evidência de comprometimento na região hipotálamo-hipofisária, e naqueles com DGHA de início na infância. Nos indivíduos que preencham estes critérios, o diagnóstico bioquímico é realizado por meio de testes dinâmicos de estímulo da secreção de GH, uma vez que seus marcadores de ação: IGF-1 e IGFBP-3 podem não distinguir indivíduos normais e pacientes com DGH. Comparado à reposição de GH realizada com dose calculada, segundo o peso ou a superfície corpórea, o tratamento atual, usando dose inicial baixa seguida pelo ajuste individualizado da dose de acordo com os níveis séricos de IGF-1, determina efeito benéfico similar com incidência menor de efeitos colaterais, melhor tolerância ao tratamento e menor dose de manutenção. Os potenciais benefícios da reposição devem ser analisados de maneira crítica e individualizada, pois nem todo o paciente apresentará benefício suficiente para justificar o tratamento. A disponibilidade de alternativas terapêuticas igualmente eficazes deve ser levada em consideração. A atividade física programada pode ocasionar melhora na composição corpórea, na capacidade cardiovascular e no bem-estar psicológico de indivíduos com DGHA sem reposição. O impacto do tratamento com hrGH sobre a qualidade de vida do paciente é importante por tornar o indivíduo mais apto social e economicamente. Os dados epidemiológicos indicam redução na expectativa de vida em pacientes com DGHA, mas a sua normalização com hrGH permanece questionável.
Adult growth hormone deficiency (AGHD) is a well-established clinical entity with heterogeneous characteristics, in which the main causes are hypothalamus-pituitary tumors and/or their treatment. The diagnosis of ADGH should be considered in patients with a prior history of childhood-onset GH deficiency or a history of organic hypothalamus-pituitary disease. In these patients diagnosis is performed biochemically by provocative tests of GH secretion, once the measurement of the biological markers for GH action:IGF-l and IGFBP-3 levels, can be in the normal range in an important percentage of AGHD patients. The current treatment using an initial low dose of hrGH followed by individualised dose titration adjusted according to serum IGF-1 levels, leads to similar beneficial effects with less incidence of side effects, improved tolerance to treatment and a lower stable GH dose as compared to hrGH replacement therapy based on body weight or body surface area. As some patients might not profit from hrGH therapy, the potential beneficial effects of hrGH replacement therapy should be analyzed on individualized basis. Alternative available therapies with similar efficacy should be taken into consideration. Physical activity may improve body compostion, cardiovascular perfomance and well being in ADGH subjects not submitted to hrGH treatment. An important target of hrGH replacement therapy is its impact on quality of life, leading to social and professional improvement. Epidemiological evidence points to a decreasing life expectancy in ADGH patients but data regarding the impact of hrGH replacement on life expectancy are still lacking.
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Adult , Humans , Growth Disorders/drug therapy , Human Growth Hormone/deficiency , Human Growth Hormone/therapeutic use , Body Composition , Body Weight , Bone Density , Biomarkers/analysis , Growth Disorders/diagnosis , /blood , Insulin-Like Growth Factor I/analysis , Quality of LifeABSTRACT
BACKGROUND: There is a clinical need for a reference value based on healthy adults in Korea. The aim of this study was to define IGF-1 concentration in healthy Korean adults and to investigate the factors relative to IGF-1 level. METHODS: By reviewing the medical records of a hospital in Korea, healthy 112 men and 109 women aged over 40 years were studied. We determined the serum IGF-1 levels of both groups according to age, sex, health behaviors, lipid profile, bone mineral density, serum albumin, waist circumference, body mass index, total testosterone, and FSH. RESULTS: IGF-1 had no sexual difference in any age group (258.7+/-84.3 ng/mL for men, 263.7+/-86.8 ng/mL for women), but correlated negatively with age (r=-0.43 and -0.35 for men and women, respectively). The mean decline was 49.6 ng/mL and 43.9 ng/mL per 10 years for men and women, respectively. IGF-1 correlated positively with serum albumin, total cholesterol, and bone mineral density of spine and femur neck. The multiple regression analysis showed that the most powerful factors influencing IGF-1 level was serum albumin (R2; 0.13) followed by age, bone mineral density of femur neck, and total cholesterol. CONCLUSION: We present a reference value for IGF-1 in healthy Korean adults aged over 40 years. The most powerful factor influencing IGF-1 level was serum albumin.
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Adult , Female , Humans , Male , Aging , Body Mass Index , Bone Density , Cholesterol , Femur Neck , Growth Hormone , Health Behavior , Insulin-Like Growth Factor I , Korea , Medical Records , Reference Values , Serum Albumin , Spine , Testosterone , Waist CircumferenceABSTRACT
BACKGROUND: Adult growth hormone (GH) deficiency is related with decreased lean body mass, increased body fat, and poor quality of life. In western countries, adult GH deficiency treatment registriesy provide a database of the effects and safety of GH deficiency treatment. The Korean Adult Growth Hormone Study Group of the Korean Society of Endocrinology register adult GH deficiency since 1996. METHEODS: Subjects were aged over 15 years, had organic hypothalamo-pituitary disease, and GH deficiency as documented by GH stimulation test or serum insulin-like growth factor-I (IGF-I) level. The underlying etiology for GH deficiency, serum IGF-I level, starting and maintenance dose, and adult GH deficiency assessment (AGHDA) score were investigated. RESULTS: From January 1996 to May 2001. 115 patients were enrolled. Mean age was 43.7 13.8 years and 60% were female. Thirteen medical institutions were involved in the registry. The most common underlying diseases were Sheehan's syndrome and pituitary adenomas. GH starting dose was from 0.4 to 1.0 units. Maintenance dose was between 0.5 and 1.2 units. Serum IGF-I levels were increased after GH treatment (0-week, 93.7 69.7 ng/mL; 2-weeks, 184.9 89.0 ng/mL; 6-weeks, 188.4 94.8 ng/mL; 10-weeks, 207.6 111.1 ng/mL; 6 months, 281.9 95.5 ng/mL). AGHDA scores slightly improved from 10.25 6.70 to 8.58 5.47 after 6 months of GH deficiency treatment. CONCLUSION: The GH Treatment Registry will be beneficial in monitoring the effects of GH deficiency treatment on Korean adult GH deficient subjects