Endocrine Abstracts (2008) 16 P369

New occurrence of diabetes mellitus in patients with adult onset GH deficiency (GHD) on GH therapy is dependent on the presence of metabolic syndrome at baseline: data from the Hypopituitary Control and Complication Study (HypoCCS)

Andrea Attanasio1, Daojun Mo2, Philippe Chanson3, Ken Ho4, Whitney Woodmansee2, David Kleinberg5 & Eva Marie Erfurth6

1Cascina del Rosone, Agliano Terme, Italy; 2Lilly Research Laboratories, Indianapolis, USA; 3Department of Endocrinology, Bicêtre University Hospital, Le Kremlin-Bicêtre, France; 4Garvan Institute of Medical Research, Sydney, Australia; 5New York University School of Medicine, New York, USA; 6University Hospital, Lund, Sweden.

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.