[The beneficial effects of growth hormone replacement therapy on elderly men]. / Korzystny wplyw uzupelniania niedoboru hormonu wzrostu u starszych mezczyzn.

UNLABELLED: The relationship of growth hormone (GH) to the ageing process is currently subject of considerably interest. The study was designed to investigate the effects of replacement therapy with growth hormone on quality of life, serum lipids and body composition (fat free mass and fat mass) in elderly men. MATERIAL: 18 healthy men 60.0 +/- 2.4 (x +/- SEM) years of age. Their body weight was 78.6 +/- 4.6 kg and body mass index (BMI) was 26.5 +/- 1.4 kg/m2. Diagnosis of GH deficiency was based on serum insulin-like growth factor-1 (IGF-1) levels below 200 micrograms/L (138.1 +/- 9.2), abolished GH nocturnal surge and diminished glucagon-stimulated GH secretion compared to reference group of young men (16.2 +/- 1.8 to 30.6 +/- 4.7 micrograms/L/hour; p < 0.02 and 10.8 +/- 1.0 to 44.1 +/- 15.3 micrograms/L/hour; p < 0.02, respectively). Reference group comprised nine men 27.5 +/- 1.3 years of age with body weight 76.3 +/- 2.2 kg and BMI 23.1 +/- 0.6 kg/m2. The subjects received recombinant, human GH daily subcutaneously during 12 months in dose adjusted to maintain optimal (280-350 micrograms/L) serum IGF-1 level. The initial dose was 0.125 IU/kg b.w./week. Before, and after 6 and 12 months of therapy clinical and laboratory exams, including serum GH, IGF-1 and lipids levels, and body composition using two methods were obtained. Quality of life was assessed by modified Beck's questionnaire. 12-months replacement therapy with growth hormone in elderly men improved mental status, increased serum IGF-1 level to the young normal men values, from 138.1 +/- 9.2 to 279.4 +/- 26.3 micrograms/L, p < 0.001, reduced serum LDL-cholesterol from 3.67 +/- 0.12 to 3.10 +/- 0.21 mmol/L, p < 0.04 and increased serum HDL and HDL2 levels from 1.20 +/- 0.05 to 1.41 +/- 0.08 mmol/L, p < 0.002 and from 0.19 +/- 0.03 to 0.34 +/- 0.06 mmol/L, p < 0.005, respectively, reduced fat mass (12.8%, p < 003), particularly localised in trunk (14.7%, p < 0.03), and increased fat free mass (2.9%, p < 0.03). GH-replacement therapy in elderly men has beneficial effects on quality of life, and may counteract ageing and atherosclerosis progression by serum lipids and body composition improvement.

[The effect of growth hormone replacement therapy on markers of bone formation and bone mineral density in elderly men]. / Wplyw uzupelniania niedoborów hormonu wzrostu na wskazniki syntezy i gestosc mineralna kosci u starszych mezczyzn.

OBJECTIVE: Decline in growth hormone (GH) secretion and serum levels of insulin-like growth factor-1 (IGF-1) during ageing may be a causal factor in the development of osteopenia. The purpose of this study was to test the effects of GH-replacement therapy on bone metabolism and mineral density in healthy men over 40 years old. MATERIAL: 18 healthy men aged 60.2 +/- 2.4 (avg +/- SEM) with mean body weight 78.6 +/- 4.6 kg and body mass index (BMI) 26.5 +/- 1.4 kg/m2. Diagnosis of growth hormone deficiency was based on serum IGF-1 levels below 200 micrograms/L (138.1 +/- 9.2), abolished GH nocturnal surge and diminished glucagon-stimulated GH secretion compared to reference group of young men (16.2 +/- 1.8 to 30.6 +/- 4.7 micrograms/L/hour; p < 0.02 and 10.8 +/- 1.0 to 44.1 +/- 15.3 micrograms/L/hour; p < 0.02 respectively). Nine healthy men aged 27.5 +/- 1.3 were recruited as a control subjects. Their body weight was 76.3 +/- 2.2 kg and BMI 21.3 +/- 0.6 kg/m2. METHODS: The subjects received human, recombinant GH (rhGH) daily subcutaneously during 12 months in dose individually adjusted to maintain optimal (280-350 micrograms/L) serum IGF-1 level. Initial dose was 0.125 IU/kg b.w./week. Before and after 6 and 12 months of therapy clinical and laboratory exams, including serum GH, IGF-1, calcium, phosphate, osteocalcin, glucose, insulin levels and alkaline phosphatase (AP) activity were obtained. Lumbar spine and femoral neck bone mineral density (BMD) were measured by dual-energy X-ray absorptiometry. RESULTS: rhGH administration for 12 months led to a significant increase in mean serum IGF-1 levels, from 138.1 +/- 9.2 to 279.4 +/- 26.3 micrograms/L (p < 0.001). Mean serum osteocalcin concentration rose from 19.4 +/- 1.7 to 34.4 +/- 4.7 micrograms/L (p < 0.004), and serum AP activity changed nearly significantly, from 78.0 +/- 4.8 to 88.1 +/- 7.2 U/L. Lumbar spine and femur neck BMD increased significantly after 12 months, from 1.092 +/- 0.05 to 1.119 +/- 0.06 g/cm2 (p < 0.05) and from 0.886 +/- 0.04 to 0.905 +/- 0.04 g/cm2 (p < 0.05), respectively. CONCLUSION: Growth hormone replacement therapy in elderly men may be regarded as a method useful to protect against osteoporosis progression.

The nurse as the knowledge worker. A management challenge.

The purpose of health care institutions is to provide quality patient care. Who renders quality patient care for these institutions? Nurses do. Without nurses, health care institutions would be unable to provide essential services; therefore, administrators need to attract and retain nurses who are knowledge workers and manage their environments effectively.