CONTEXT: Adult GH deficiency (GHD) is associated with impaired quality of life (QoL) and increased cardiovascular risk. Continued long-term efficacy in terms of QoL and cardiovascular risk factors has been indicated in open surveillance studies. OBJECTIVES: The aim was to study the impact of discontinuation of long-term GH replacement on QoL, body composition, and metabolism. DESIGN AND SETTING: We conducted a randomized, double-blind, placebo-controlled 4-month crossover trial in a referral center. PATIENTS: Sixty adult hypopituitary patients with GHD and more than 3 yr of continuous GH replacement therapy (mean treatment duration, 10 yr) participated in the study. INTERVENTION: Patients received GH or placebo. MAIN OUTCOME MEASUREMENTS: We measured QoL using validated questionnaires; body composition using computer tomography, dual-energy x-ray absorptiometry, and bioelectrical impedance spectroscopy; and insulin sensitivity using the short insulin tolerance test. RESULTS:Mean serum IGF-I decreased from 168 ± 52 to 98 ± 47 μg/liter during the placebo period (P < 0.001). Two QoL domains (emotional reactions and positive well-being) in the Nottingham Health Profile and Psychological General Well-Being questionnaires deteriorated during placebo, compared with GH treatment (P < 0.05). Waist circumference and sc and visceral fat mass increased, and extracellular water and muscle area decreased during the placebo period (all P < 0.05). C-reactive protein and total-, low-density lipoprotein-, and high-density lipoprotein-cholesterol increased, and insulin sensitivity improved during placebo, compared to GH treatment (P < 0.05). CONCLUSION: After more than 3 yr of GH replacement therapy, a 4-month period of placebo treatment caused self-perceived deterioration in QoL and increased abdominal fat accumulation. Moreover, markers of systemic inflammation and lipid status deteriorated, whereas insulin sensitivity improved. Long-term continuous GH replacement is needed to maintain therapeutic effects of GH on QoL and cardiovascular risk factors.
RCT Entities:
CONTEXT: Adult GH deficiency (GHD) is associated with impaired quality of life (QoL) and increased cardiovascular risk. Continued long-term efficacy in terms of QoL and cardiovascular risk factors has been indicated in open surveillance studies. OBJECTIVES: The aim was to study the impact of discontinuation of long-term GH replacement on QoL, body composition, and metabolism. DESIGN AND SETTING: We conducted a randomized, double-blind, placebo-controlled 4-month crossover trial in a referral center. PATIENTS: Sixty adult hypopituitary patients with GHD and more than 3 yr of continuous GH replacement therapy (mean treatment duration, 10 yr) participated in the study. INTERVENTION: Patients received GH or placebo. MAIN OUTCOME MEASUREMENTS: We measured QoL using validated questionnaires; body composition using computer tomography, dual-energy x-ray absorptiometry, and bioelectrical impedance spectroscopy; and insulin sensitivity using the short insulin tolerance test. RESULTS: Mean serum IGF-I decreased from 168 ± 52 to 98 ± 47 μg/liter during the placebo period (P < 0.001). Two QoL domains (emotional reactions and positive well-being) in the Nottingham Health Profile and Psychological General Well-Being questionnaires deteriorated during placebo, compared with GH treatment (P < 0.05). Waist circumference and sc and visceral fat mass increased, and extracellular water and muscle area decreased during the placebo period (all P < 0.05). C-reactive protein and total-, low-density lipoprotein-, and high-density lipoprotein-cholesterol increased, and insulin sensitivity improved during placebo, compared to GH treatment (P < 0.05). CONCLUSION: After more than 3 yr of GH replacement therapy, a 4-month period of placebo treatment caused self-perceived deterioration in QoL and increased abdominal fat accumulation. Moreover, markers of systemic inflammation and lipid status deteriorated, whereas insulin sensitivity improved. Long-term continuous GH replacement is needed to maintain therapeutic effects of GH on QoL and cardiovascular risk factors.
Authors: G Aimaretti; R Attanasio; S Cannavò; M C Nicoletti; R Castello; C Di Somma; P Garofalo; L Iughetti; S Loche; M Maghnie; L Mazzanti; G Saggese; M Salerno; G Tonini; V Toscano; S Zucchini; M Cappa Journal: J Endocrinol Invest Date: 2014-11-02 Impact factor: 4.256
Authors: A Blasetti; S Franchini; V Castorani; L Comegna; E Fornari; F Daniele; G Prezioso; C Piona; V Federico; D Zona; I Bresadola; F Chiarelli; C Maffeis Journal: Int J Endocrinol Date: 2020-10-10 Impact factor: 3.257
Authors: Artur Galimov; Angelika Hartung; Roman Trepp; Alexander Mader; Martin Flück; Axel Linke; Matthias Blüher; Emanuel Christ; Jan Krützfeldt Journal: J Mol Med (Berl) Date: 2015-07-23 Impact factor: 4.599
Authors: Balázs Ratku; Veronika Sebestyén; Annamária Erdei; Endre V Nagy; Zoltán Szabó; Sándor Somodi Journal: Pituitary Date: 2022-02-01 Impact factor: 4.107