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Wachstumshormontherapie beim Erwachsenen

Versuch einer Bilanz nach einer Dekade

Growth hormone therapy in adults. Attempt to assess a decade of use

  • Schwerpunkt: Hormontherapie
  • Published:
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Zusammenfassung

Patienten mit adultem Wachstumshormonmangel können offenbar unabhängig vom Ausfall und von der Substitution weiterer hypophysärer Achsen ein Krankheitsbild mit zentral betonter Adipositas, Dyslipidämie, verminderter Knochendichte und erhöhter Frakturrate sowie psychosozialen Einschränkungen entwickeln. Dabei ist das Ausmaß dieser Veränderungen starken interindividuellen Schwankungen unterlegen. Retrospektive Analysen weisen auf eine möglicherweise erhöhte kardiovaskuläre Morbidität und Mortalität dieses Patientenkollektivs hin, welche durch die proatherogenen Veränderungen (zentrale Adipositas, Dyslipidämie) bedingt sein könnten. Die Therapie mit rekombinantem Wachstumshormon führt in kontrollierten Studien neben einer deutlichen Verbesserung der Lebensqualität zur Verbesserung der Körperzusammensetzung und des Lipidprofils sowie zur Erhöhung der Knochendichte. Ob sich diese Verbesserungen auch in der Reduktion von Endpunkten (Senkung der Frakturraten, Senkung der kardiovaskulären Morbidität und Mortalität) auszahlt, ist durch kontrollierte Studien bislang nicht belegt. Bei Verwendung niedriger Dosen, die anhand des IGF-1-Spiegels titriert werden, scheint die Wachstumshormonsubstitution eine sichere, gut verträgliche Therapie zu sein.

Abstract

Patients with adult growth hormone deficiency apparently can develop a clinical picture with pronounced obesity, dyslipidemia, decreased bone density, and increased fracture rate as well as psychosocial limitations irrespective of the loss and replacement of further hypophyseal axes. The extent of these changes is strongly dependent on interindividual variations. Retrospective analyses have indicated a possibility of elevated morbidity and mortality among this patient cohort which can be due to the proatherogenic alterations (central obesity, dyslipidemia). Treatment with recombinant growth hormone in controlled trials resulted in evident improvement in quality of life, better body composition and lipid profile as well as an increase in bone density. Whether these improvements will also pay off in terms of reduction of endpoints (decline in fracture rates, decrease of cardiovascular morbidity and mortality) has not yet been confirmed by controlled studies. When administered at low doses, titrated according to the IGF-1 level, growth hormone replacement appears to be a safe and well-tolerated therapeutic regimen.

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Der korrespondierende Autor weist auf folgende Beziehungen hin:

Hiermit erkläre ich, dass ich in den vergangenen 3 Jahren folgende Beziehungen zu Pharmafirmen unterhalten habe, die Produkte herstellen, die mit dem Artikel in Zusammenhang stehen:

Ich bin Mitglied des KIMS-Boards, einem wissenschaftlichen Beirat der deutschen Gruppe der internationalen Langzeitanwendungsbeobachtung für den Einsatz von Genotropin® bei erwachsenen Patienten mit Wachstumshormonmangel. Diese Anwendungsbeobachtung wird von der Firma Pfizer GmbH finanziert.

Die Firmen Pfizer und NovoNordisk haben wissenschaftliche Untersuchungen zum Thema Hypophyse, die ich an der Universität zu Köln verantwortlich durchgeführt habe, bzw. durchführe, finanziell unterstützt.

Ich habe in den vergangenen Jahren wissenschaftliche Vorträge auf endokrinologischen Symposien gehalten und hierfür Honorare von den Firmen

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  1. Klinik II und Poliklinik für Innere Medizin, Klinikum der Universität zu Köln, Kerpener Straße 62, 50937, Köln, Deutschland

    M. Faust

  2. Klinische Endokrinologie, Charité – Campus Mitte, Berlin, Deutschland

    C.J. Strasburger

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Faust, M., Strasburger, C. Wachstumshormontherapie beim Erwachsenen. Internist 49, 527–537 (2008). https://doi.org/10.1007/s00108-008-2140-x

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