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Shin, Jeong, Cho, Choi, Kim, Chae, Cho, Lee, Lee, Park, Hong, Kim, Kim, Yu, Ihm, Choi, Yoo, and Park: The Changes in Atherosclerotic Markers and Adiopocytokines after Treatment with Growth Hormone for the Patients with Hypopituitarism and Growth Hormone Deficiency
Original Article
Journal of Korean Endocrine Society

Journal of Korean Endocrine Society 2006; 21(6): 515-525.

Published online: 20 December 2006

DOI: https://doi.org/10.3803/jkes.2006.21.6.515

The Changes in Atherosclerotic Markers and Adiopocytokines after Treatment with Growth Hormone for the Patients with Hypopituitarism and Growth Hormone Deficiency

Hyun Won Shin1, In-Kyung Jeong1, 2, Goo Yeong Cho1, Cheul Young Choi1, Jong-Yeop Kim1, Yeong Je Chae1, Min-Ho Cho1, Byung-Wan Lee1, Seong-Jin Lee1, Chul Young Park1, Eun-Gyoung Hong1, Hyeon-Kyu Kim1, Doo-Man Kim1, Jae-Myung Yu1, Sung-Hee Ihm1, Moon-Ki Choi1, Hyung-Joon Yoo1, Sung-Woo Park1

1Department of Internal Medicine, Hallym University College of Medicine and Division of Endocrinology and Metabolism, Korea.

2Department of Internal Medicine, KyungHee University College of Medicine, and Division of Endocrinology and Metabolism, Korea.

Received 8 February 2005       Accepted 23 June 2006

Copyright © 2006 Korean Endocrine Society

Abstract

Background

It is known that patients with hypopituitarism have a high mortality rate due to the presence of atherosclerosis, cardiovascular diseases and stroke. The aim of this study was the effect of growth hormone (GH) on the atherosclerotic markers and the adipocytokine levels.

Method

The study was conducted on 13 adult patients with hypopituitarism and growth hormone deficiency (GHD), and they had been stabilized after receiving hormone replacement therapy for other insufficient pituitary hormones, other than GH, for more than one year. Before treatment with GH, we compared the lipid metabolism, glucose metabolism, cardiovascular risk factors and adipocytokine levels, including adiponectin, leptin, TNF-α and IL-6, between the GHD patients and 13 healthy adults who were of a similar age and gender distribution.
Patients with GHD were treated with 1 U/day of GH for 6 months. We measured insulin-like growth factor-I (IGF-I), blood pressure, body composition, lipid metabolism, glucose metabolism and hs-CRP, cardiac function, adiponectin, leptin, TNF-α and IL-6 levels, flow mediated vasodilation (FMD) and nitroglycerin mediated vasodilation (NMD) before and after GH treatment.

Results

The patients with hypopituitarism and GHD showed significantly higher levels of total cholesterol (P = 0.002), low-density lipoprotein cholesterol (LDL-C) (P = 0.036), hs-CRP (P = 0.0087) and leptin (P < 0.001) than did the normal healthy adults. However, there was no difference between the normal adults and the patients with GHD for the systolic and diastolic BP, the levels of apoA, apoB, fasting blood glucose(FBG) and HOMA-IR. In the subjects with GHD after treatment with GH, the level of fat mass (P = 0.0017), total cholesterol (P = 0.004), LDL-C (P = 0.001), leptin (P = 0.013), TNF-α (P < 0.001) and hs-CRP (P = 0.0001) were significantly reduced, while lean body mass (P = 0.0161), FFA (P = 0.049) and FMD (P = 0.0051) showed a significant increase. However, there was no significant difference in the level of the systolic and diastolic BP, LDL-C, apoA, apoB, LP (a), HOMA-IR, ejection fraction, left ventricular posterior wall, E/A ratio, intraventricular septum, NMD, intima-media thickness, adiponectin, IL-6, FBG and fasting insulin before and after GH treatment.

Conclusion

The subjects with GHD were vulnerable to cardiovascular disease. GH therapy for 6 months had a positive effect on their various cardiovascular risk factors.

Keywords: Adipocytokine, Cardiac function, Cardiovascular risk factor, Endothelial cell function, Growth hormone, Growth hormone deficiency

Figures and Tables

Fig. 1
The changes of fat mass (FM) (A), lean body mass (LBM) (B), bone mineral density (BMD) (C) before (pre GH) and after 6 months (post GH) of growth hormone (GH) therapy. The level of fat mass significantly decreased and lean body mass significantly increased after 6 months of GH therapy. *P < 0.05 vs. pre GH.
jkes-21-515-g001
Fig. 2
The change of total cholesterol (TC) (A), triglyceride (TG) (B), high-density lipoprotein cholesterol (HDL-C) (C), low-density lipoprotein cholesterol (LDL-C) (D) before (pre GH) and after 6 months (post GH) of growth hormone (GH) therapy. The level of total cholesterol and LDL-C levels significantly decreased after 6 months of GH therapy. *P < 0.05 vs. pretreatment with GH.
jkes-21-515-g002
Fig. 3
The change of apolipoprotein-A (A), apolipoprotein-B (B), lipoprotein (a) (Lp (a)) (C), free fatty acid (FFA) (D) before (pre GH) and after 6 months (post GH) of GH therapy. Free fatty acid level significantly increased after 6 months of GH therapy. *P < 0.05 vs pre GH,
jkes-21-515-g003
Fig. 4
The changes of leptin (A), adioponectin (B), tumor necrosis factor-α (TNF-α) (C),interleukin-6 (IL-6) (D) before (pre GH) and after 6 months (post GH) of growth hormone (GH) therapy. Leptin and TNF-α levels significantly decreased after 6 months of GH therapy. *P < 0.05 vs. pre GH.
jkes-21-515-g004
Fig. 5
The change of hs-CRP level before (pre GH) and after 6 months (post GH) of growth hormone (GH) therapy. hs-CRP levels significantly decreased at 6 months. *P < 0.05 vs. pre GH.
jkes-21-515-g005
Fig. 6
The changes of flow mediated vasodilation (FMD) (A), nitroglycerin mediated vasodilation (NMD) (B) before (pre GH) and after 6months (post GH) of growth hormone (GH) therapy. FMD level increased significantly after 6 months of GH therapy. *P < 0.05 vs. pre GH.
jkes-21-515-g006
Table 1
Clinical characteristics of patients with growth hormone deficiency (GHD) and healthy control
jkes-21-515-i001

SBP, systolic blood pressure; DBP, diastolic blood pressure; LDL-C, low density lipoprotein cholesterol; HDL-C, high density lipoprotein cholesterol; ApoA, apoprotein-A; ApoB, apoprotein-B; hs CRP, high sensitivity C-reacitve protein; TNF-α, tumor necrosis factor-α; IL-6, interleukin-6; NS, non-significant.

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