Patients with adult onset GHD (AO-GHD) manifest features of the metabolic syndrome (MetS) (abdominal obesity, dyslipidemia and insulin resistance), a condition associated with increased risk of diabetes mellitus (DM).
We assessed metabolic status before and after 2 years of GH treatment and the occurrence of de novo DM in 712 patients with AO-GHD from HypoCCS drawn from the US (32.2%) and Europe (67.8%). Patients were divided into four BMI categories (<25, 25<30, 30<35, ≥35 kg/m2), and MetS defined by the National Cholesterol Education Program (NCEP) criteria. De novo DM was recorded from reporting of a new event and/or newly initiated diabetes treatment. The baseline prevalence of MetS was 43.0% with a linear increase across BMI categories from 11.0% to 73.9%. The baseline prevalence of DM was related to BMI and the presence or absence of pre-existing MetS, being 3.1 vs 18.8% for a BMI <25 kg/m2 and 6.7 vs 43.5% for a BMI ≥35 kg/m2, respectively. GH treatment did not change the prevalence of MetS (43.0 vs 44.2%). In those without pre-existing MetS (n=406), DM developed in 0.0, 2.4, 0.0 and 0.0% for BMI categories <25, 25<30, 30<35 and ≥35, respectively. In those with MetS (n=306), DM developed in 7.7, 11.9, 6.3 and 18.8% for the same BMI categories, respectively.
In summary, the prevalence of MetS is high in adults with GHD and is unchanged by 2 years of GH treatment. However, pre-existing MetS and BMI were strong determinants of the development of DM. Patients with AO-GHD with pre-existing MetS are at increased risk of developing DM during GH treatment, a risk that is worsened by increasing BMI. Greater vigilance should be exercised for early identification and therapy of DM in these patients.
03 - 07 May 2008
European Society of Endocrinology