Skip to main content
SpringerLink
Log in

Effects of GH replacement on metabolism and physical performance in GH deficient adults

  • Published:
Journal of Endocrinological Investigation Aims and scope Submit manuscript

    We’re sorry, something doesn't seem to be working properly.

    Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Abstract

GH deficiency (GHD) in adults is associated with abnormalities in body composition, metabolic derangements, sub-optimal physical performance, high incidence of adverse cardiovascular risk factors and poor quality of life. GHD adults are insulin resistant and have reduced hepatic glycogen stores, reduced insulin stimulated glucose utilization and reduced glycogen synthesis in muscle. GH replacement results in either no change or slight reduction in insulin sensitivity. Hence, it is important to monitor for the development of glucose intolerance in patients on long-term GH replacement. GHD is associated with a lipid profile known to predispose to premature atherosclerosis and cardiovascular disease, i.e. increased total and LDL cholesterol, decreased HDL cholesterol, increased small dense LDL particles and increased triglycerides. LDL-cholesterol abnormalities appear to improve with GH replacement even if maintained within physiological dose range; the greatest improvement occurs in those subjects with higher baseline total and LDL cholesterol values and in female patients with adult onset GHD compared with male patients with childhood onset GHD. In contrast, hypertriglyceridaemia is not corrected by GH replacement. The majority of the reports suggest GH replacement increases Lipoprotein-a levels. Long-term observation will be required to determine whether GH replacement reduces cardiovascular morbidity and mortality in GHD adults. The reduced muscle mass and strength associated with GHD has been shown to improve after GH replacement. GH treatment also improves maximal and sub-maximal exercise performance in GHD adults. The effects on protein metabolism, energy expenditure and thyroid metabolism in GHD adults are also critical.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Cuneo RC, Salomon F, McGauley GA, Sonksen PH. The growth hormone deficiency syndrome in adults. Clin Endocrinol (Oxf) 1992, 37: 387–97.

    Article  CAS  Google Scholar 

  2. Hew FL, Koschmann M, Christopher M, et al. Insulin resistance in growth hormone-deficient adults: defects in glucose utilisation and glycogen synthetase activity. J Clin Endocrinol Metab 1996, 81: 555–6.

    PubMed  CAS  Google Scholar 

  3. O’Neal DN, Kalfas A, Dunning PL, et al. The effects of 3 months of recombinant human growth hormone (GH) therapy on insulin and glucose-mediated glucose disposal and insulin secretion in GH-deficient adults: a minimal model analysis. J Clin Endocrinol Metab 1994, 79: 975–83.

    PubMed  Google Scholar 

  4. Beshyah SA, Henderson A, Niththyananthan R, et al. Metabolic abnormalities in growth hormone deficient adults II carbohydrate tolerance and lipid metabolism. Endocrinol Metab 1994, 1: 173–80.

    Google Scholar 

  5. Johansson JO, Fowelin J, Landin K, et al. Growth hormone deficient adults are insulin resistant. Metabolism 1995, 44: 1126–9.

    Article  PubMed  CAS  Google Scholar 

  6. Weaver JU, Monson JP, Noonan K, et al. The effect of low dose recombinant human growth hormone replacement on regional fat distribution, insulin sensitivity and cardiovascular risk factors in hypopituitary adults. J Clin Endocrinol Metab 1995, 80: 153–9.

    PubMed  CAS  Google Scholar 

  7. Salomon F, Cuneo RC, Umpleby AM, Sonksen PH. Glucose and fat metabolism in adults with growth hormone deficiency. Clin Endocrinol (Oxf) 1994, 41: 315–22.

    Article  CAS  Google Scholar 

  8. Salomon F, Cuneo RC, Hesp R, Sonksen PH. The effects of treatment with recombinant human growth hormone on body composition and metabolism in adults with growth hormone deficiency. N Engl J Med 1989, 321: 1797–803.

    Article  PubMed  CAS  Google Scholar 

  9. Beshyah SA, Henderson A, Niththyananthan R, et al. The effects of short term and long term growth hormone replacement therapy in hypopituitary adults on lipid metabolism and carbohydrate tolerance. J Clin Endocrino Metab 1995, 80: 356–63.

    CAS  Google Scholar 

  10. Fowelin J, Attvall S, Lager I, Bengtsson BA. Effects of treatment with recombinant human growth hormone on insulin sensitivity and glucose metabolism in adults with growth hormone deficiency. Metabolism 1993, 42: 1443–7.

    Article  PubMed  CAS  Google Scholar 

  11. Bulow B, Erfurth EM. A low individualised GH dose in young patients with childhood onset GH deficiency normalised serum IGF-I without significant deterioration in glucose tolerance. Clin Endocrinol (Oxf) 1999, 50: 45–55.

    Article  CAS  Google Scholar 

  12. Rosenfalck AM, Maghsoudi S, Fisker S, et al. The effect of 30 months of low dose replacement therapy with recombinant human growth hormone on Insulin and C-Peptide kinetics, Insulin secretion, Insulin sensitivity, Glucose effectiveness, and body composition in GHD adults. J Clin Endocrinol Metab 2000, 85: 4173–81.

    Article  PubMed  CAS  Google Scholar 

  13. Hwu CM, Kwok CF, Lai TY, et al. Growth hormone (GH) replacement reduces total body fat and normalises insulin sensitivity in GH-deficient adults: a report of one- year clinica experience. J Clin Endocrinol Metab 1997, 82: 3285–92.

    PubMed  CAS  Google Scholar 

  14. Christopher M, Hew FL, Oakley M, et al. Defects of insulin action and skeletal muscle glucose metabolism in growth hormone-deficient adults persists following 24 months recombinant growth hormone (rhGH) therapy. J Clin Endocrinol Metab 1998, 83: 1668–81.

    PubMed  CAS  Google Scholar 

  15. Al-Shoumer KAS, Cox KH, Hughes CL, et al. Fasting and postprandial lipid abnormalities in hypopituitary women receiving conventional replacement therapy. J Clin Endocrinol Metab 1997, 82: 2653–9.

    PubMed  CAS  Google Scholar 

  16. Cuneo RC, Salomon F, Watts GF, et al. Growth hormone treatment improves serum lipids and lipoproteins in adults with growth hormone deficiency. Metabolism 1993, 42: 1519–23.

    Article  PubMed  CAS  Google Scholar 

  17. De Boer H, Blok GJ, Voerman HJ, et al. Serum Lipid levels in growth hormone deficient men. Metabolism 1994, 43: 199–203.

    Article  PubMed  Google Scholar 

  18. O’Neal DN, Hew FL, Sikaris K, et al. Low density lipoprotein particle size in hypopituitary adults on conventiona hormone replacement therapy. J Clin Endocrinol Metab 1996, 81: 2448–54.

    PubMed  Google Scholar 

  19. Attanasio AF, Lamberts SWJ, Matranga AMC, et al. Adult growth hormone (GH)-deficient patients demonstrate heterogeneity between childhood onset and adult onset before and during human GH treatment. J Clin Endocrinol Metab 1997, 82: 82–8.

    PubMed  CAS  Google Scholar 

  20. Russell-Jones DL, Watts GF, Weissberger AJ, et al. The effect of growth hormone replacement on serum lipids, ipoproteins, apolipoproteins and cholesterol precursors in adult growth hormone deficient patients. Clin Endocrinol (Oxf) 1994, 41: 345–50.

    Article  CAS  Google Scholar 

  21. Murray RD, Wieringa GE, Lissett CA, et al. Low dose GH replacement improves the adverse lipid profile associated with the adult GH deficiency syndrome. Clin Endocrinol (Oxf) 2002, 56: 525–32.

    Article  CAS  Google Scholar 

  22. Leese GP, Wallymahmed M, Wieringa G, et al. Apo E phe-notype and changes in serum lipids in adult patients during growth hormone replacement. Eur J Endocrinol 1999, 140: 174–9.

    Article  PubMed  CAS  Google Scholar 

  23. Webster JM, Stewart M, Al-Maskari M, et al. The effect of Growth hormone replacement therapy for up to 12 months on lipoprotein composition and lipoprotein (a) in growth hormone-deficient adults. Atherosclerosis 1997, 133: 115–21.

    Article  PubMed  CAS  Google Scholar 

  24. O’ Neal DN, Hew FL, Best JD, Alford F. The effect of 24 months recombinant human growth hormone on LDL cholesterol, triglyceride-rich lipoproteins and apo(a) in hypopituitary adults previously treated with conventional replacement therapy. Growth Horm IGF Res 1999, 9: 165–73.

    Article  Google Scholar 

  25. Wieringa G, Toogood AA, Ryder WDJ, et al. Changes in ipoprotein (a) levels measured by six kit methods during growth hormone treatment of growth hormone deficient adults. Growth Horm IGF Res 2000, 10: 14–9.

    Article  PubMed  CAS  Google Scholar 

  26. Angelin B, Rudling M. Growth hormone and lipoprotein metabolism. Endocrinol Metab 1995, 2: 25–8.

    Google Scholar 

  27. Rudling M, Parini P, Angelin B. Growth hormone and bile acid synthesis. Key role for the activity of hepatic microsomal cholesterol 7α-hydroxylase in the rat. J Clin Invest 1997, 99: 2239–45.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  28. Christ ER, Cummings MH, Albany E, et al. Effects of Growth hormone replacement therapy on Very Low Density Lipoprotein Apolipoprotein B 100 kinetics in patients with Adult GH deficiency: A Stable Isotope Study. J Clin Endocrinol Metab 1999, 84: 307–16.

    PubMed  CAS  Google Scholar 

  29. Oscarsson J, Lundstam U, Gustafsson B, et al. Recombinant human insulin like growth factor-1 decreases serum lipoprotein (a) concentrations in normal adult men. Clin Endocrinol (Oxf) 1995, 42: 673–6.

    Article  CAS  Google Scholar 

  30. Laron Z, Wang XL, Klinger B, et al. Growth hormone increases and insulin like growth factor-1 decreases circu-ating lipoprotein (a). Eur J Endocrinol 1997, 136: 377–81.

    Article  PubMed  CAS  Google Scholar 

  31. Fryburg DA, Gelfand RA, Barrett EJ. Growth hormone acutely stimulates muscle protein synthesis in normal humans. Am J Physiol 1991, 260: E 499–504.

    CAS  Google Scholar 

  32. Beshyah SA, Sharp PS, Gelding SV, et al. Whole body eucine turnover in adults on conventional treatment for hypopituitarism. Acta Endocrinol (Copenh) 1993, 129: 158–64.

    CAS  Google Scholar 

  33. Hoffman DM, Pallasser R, Duncan M, et al. How is whole body protein turnover perturbed in growth hormone deficient adults? J Clin Endocrinol Metab 1998, 83: 4344–9.

    PubMed  CAS  Google Scholar 

  34. Binnerts A, Swart GR, Wilson JHP, et al. The effect of growth hormone administration in growth hormone deficient adults on bone, protein, carbohydrate and lipid homeostasis, as well as on body composition. Clin Endocrinol (Oxf) 1992, 37: 79–87.

    Article  CAS  Google Scholar 

  35. Russell-Jones DL, Weissberger AJ, Bowes SB, et al. The effects of growth hormone on protein metabolism in adult growth hormone deficient patients. Clin Endocrinol (Oxf) 1993, 38: 427–31.

    Article  CAS  Google Scholar 

  36. Norrelund H, Moller N, Nair KS, et al. Continuation of growth hormone substitution during fasting in GH deficient patients decreases urea excretion and conserves protein synthesis. J Clin Endocrinol Metab 2001, 86: 3120–9.

    PubMed  CAS  Google Scholar 

  37. Haymond MW, Horber FF, DeFeo P, et al. Effect of human growth hormone and insulin-like growth factor 1 on whole-body leucine and estimates of protein metabolism. Horm Res 1993, 40:92–4.

    Article  PubMed  CAS  Google Scholar 

  38. Lucidi P, Lauteri M, Laureti S, et al. A dose response study of growth hormone (GH) replacement on whole body protein and lipid kinetics in GH deficient adults. J Clin Endocrinol Metab 1998, 83: 353–7.

    Article  PubMed  CAS  Google Scholar 

  39. O’ Sullivan AJ, Kelly JJ, Hoffman DM, et al. Body composition and energy expenditure in Acromegaly. J Clin Endocrinol Metab 1994: 78: 381–6.

    Google Scholar 

  40. Snel YEM, Doerga ME, Brummer RM, et al. Resting metabolic rate, body composition and related hormona parameters in growth hormone deficient adults before and after growth hormone replacement therapy. Eur J Endocrinol 1995, 133: 445–50.

    Article  PubMed  CAS  Google Scholar 

  41. Chong PKK, Jung RT, Scrimgeour CM, et al. Energy expenditure and body composition in growth hormone deficient adults on exogenous growth hormone. Clin Endocrinol (Oxf) 1994, 40: 103–10.

    Article  CAS  Google Scholar 

  42. Wolthers T, Grofte T, Moller N, et al. Calorigenic effects of growth hormone: The role of thyroid hormones. J Clin Endocrinol Metab 1996, 81: 1416–9.

    PubMed  CAS  Google Scholar 

  43. Moller J, Jorgensen JO, Moller N, et al. Effects of growth hormone administration on fuel oxidation and thyroid function in normal man. Metabolism 1992, 41: 728–31.

    Article  PubMed  CAS  Google Scholar 

  44. Jorgensen JOL, Moller J, Laursen T, et al. Growth hormone administration stimulates energy expenditure and extrathyroidal conversion of thyroxine to triiodothyronine in a dose-dependent manner and suppresses circadian thyrotrophin levels: studies in GH deficient adults. Clin Endocrinol (Oxf) 1994, 41: 609–14.

    Article  CAS  Google Scholar 

  45. Cuneo RC, Salomon F, Wiles CM, Sonksen PH. Skeleta muscle performance in adults with growth hormone deficiency. Horm Res 1990, 33: 55–60.

    Article  PubMed  Google Scholar 

  46. Whitehead HM, Gilliland JS, Allen IV, Hadden DR. Growth hormone treatment in adults with growth hormone deficiency: effect on muscle fibre size and proportions. Acta Paediatr Scand 1989, 356 (Suppl): 65–7.

    Article  CAS  Google Scholar 

  47. Cuneo RC, Salomon F, Wiles CM, et al. Growth hormone treatment in growth hormone deficient adults. I. Effects on muscle mass and strength. J Appl Physiol 1991, 70(2): 688–94.

    PubMed  CAS  Google Scholar 

  48. Rutherford OM, Beshyah SA, Johnston DG. Quadriceps strength before and after growth hormone replacement in hypopituitary adults: Relationship to changes in lean body mass and IGF-I. Endocrinol Metab 1994, 1: 41–7.

    CAS  Google Scholar 

  49. Janssen YJH, Doornbos J, Roelfsema F. Changes in muscle volume, strength, and bioenergetics during recombinant human growth hormone therapy in adults with GH deficiency. J Clin Endocrinol Metab 1999, 84: 279–84.

    PubMed  CAS  Google Scholar 

  50. Cuneo RC, Salomon F, Wiles CM, et al. Growth hormone treatment in growth hormone deficient adults. II. Effects on exercise performance. J Appl Physiol 1991, 70: 695–700.

    PubMed  CAS  Google Scholar 

  51. Woodhouse LJ, Asa SL, Thomas SG, et al. Measures of sub-maximal aerobic performance evaluate and predict functional response to growth hormone (GH) treatment in GH deficient adults. J Clin Endocrinol Metab 1999, 84: 4570–7.

    PubMed  CAS  Google Scholar 

  52. Jorgensen JOL, Vahl N, Hansen TB, et al. Growth hormone versus placebo treatment for one year in growth hormone deficient adults: increase in exercise capacity and normalisation of body composition. Clin Endocrinol (Oxf) 1996, 45: 681–8.

    Article  CAS  Google Scholar 

  53. Gullestad L, Birkland K, Bjonerheim R, et al. Exercise capacity and hormonal response in adults with childhood onset growth hormone deficiency during long-term somat-ropin treatment. Growth Horm IGF Res 1998, 8: 377–84.

    Article  PubMed  CAS  Google Scholar 

  54. Nass R, Huber RM, Klauss V, et al. Effect of growth hormone replacement therapy on physical work capacity and cardiac and pulmonary function in patients with GH deficiency acquired in adulthood. J Clin Endocrinol Metab 1995, 80: 552–7.

    PubMed  CAS  Google Scholar 

  55. Jorgensen JOL, Thuesen L, Muller J, et al. Three years of growth hormone treatment in growth hormone deficient adults: near normalization of body composition and physical performance. Eur J Endocrinol 1994, 130: 224–8.

    Article  PubMed  CAS  Google Scholar 

  56. Cittadini A, Cuocolo A, Merola B, et al. Impaired cardiac performance in GH deficient adults and its improvement after GH replacement. Am J Physiol 1994, 267: E219–25.

    PubMed  CAS  Google Scholar 

  57. Claustres M, Chatelain P, Sultan C. Insulin-like growth factor stimulates human erythroid colony formation in vitro. J Clin Endocrinol Metab 1987, 65: 78–82.

    Article  PubMed  CAS  Google Scholar 

  58. Cuneo RC, Judd S, Wallace JD, et al. The Australian multi-centre trial of growth hormone (GH) treatment in GH deficient adults. J Clin Endocrinol Metab 1998, 83: 107–16.

    PubMed  CAS  Google Scholar 

  59. Chrisoulidou A, Beshyah SA, Rutherford O, et al. Effects of 7 years of Growth hormone replacement therapy in hypopituitary adults. J Clin Endocrinol Metab 2000, 85: 3762–9.

    PubMed  CAS  Google Scholar 

  60. Gibney J, Wallace JD, Spinks T, et al. The Effects of 10 years of Recombinant Human Growth hormone in adult GH deficient patients. J Clin Endocrinol Metab 1999, 84: 2596–602.

    Article  PubMed  CAS  Google Scholar 

  61. Florakis D, Hung V, Kaltsas G, et al. Sustained reduction in circulating cholesterol in adult hypopituitary patients given low dose titrated growth hormone replacement therapy: a two year study. Clin Endocrino (Oxf) 2000, 53: 453–9.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Endocrinology, Christie Hospital, Wilmslow Road, Manchester, M20 4BX, UK

    S. K. Abdul Shakoor &  S. M. Shalet

Authors
  1. S. K. Abdul Shakoor
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. M. Shalet
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. M. Shalet.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Abdul Shakoor, S.K., Shalet, S.M. Effects of GH replacement on metabolism and physical performance in GH deficient adults. J Endocrinol Invest 26, 911–918 (2003). https://doi.org/10.1007/BF03345243

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03345243

Key-words

Search

Navigation