GH replacement boosts cardiopulmonary function

By Eleanor McDermid
J Clin Endocrinol Metab 2017; Advance online publication
29 September 2017

medwireNews: A study confirms the presence of impaired cardiac performance, body composition and cardiopulmonary function in children with growth hormone deficiency (GHD), all of which are reversed by GH replacement.

Mariacarolina Salerno (Federico II University, Naples, Italy) and colleagues studied 17 boys and four girls with untreated GHD, who were aged an average of 11.3 years at enrolment.

These patients had significantly altered left ventricle (LV) structure compared with 21 controls who had familial short stature or constitutional delay of growth and puberty and were matched to the patients by sex, pubertal status, BMI and level of physical activity. The patients had reduced LV end-systolic and end-diastolic diameter, interventricular septal thickness and posterior wall thickness, which together resulted in a significantly lower LV mass, at 63.32 versus 80.44 g/m2 in controls.

During the first year of GH therapy, however, these parameters significantly improved in the GHD patients, so that LV mass increased to 72.01 g/m2, which was not significantly different from the 80.84 g/m2 measured in the control group.

Baseline cardiopulmonary testing revealed significantly lower values for VO2 peak (peak oxygen consumption), VO2 peak% predicted and O2 pulse in the GHD patients compared with controls

Despite the lack of any obvious limitation in the patients’ physical activity, the researchers say the data suggest that GHD confers a limitation in exercise capacity, noting in particular the reduction in the gold standard measure of exercise capacity, VO2 peak.

Again, these parameters improved during the first year of GH therapy; for example, VO2 peak was 22.92 versus 27.48 mL/kg per min in patients versus controls at baseline, but 26.80 versus 28.44 mL/kg per min after 1 year.

“These results are particularly interesting since a better cardiopulmonary performance in childhood is associated to long-term beneficial effects such as reduced [cardiovascular] risk and improved bone mineral density and psychological well-being”, write Salerno and team in The Journal of Clinical Endocrinology & Metabolism.

Patients also had poorer body composition than controls at baseline, with significantly less lean body mass and more fat mass. During the first year of GH treatment, they had significant increases in lean mass and a trend towards a reduction in fat mass, bringing their percentage lean and fat mass in line with that of the controls.

These findings on body composition are in line with the “scanty” data already available in children and adolescents with GHD, says the team.

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