Endocrine Abstracts

Metabolic abnormalities in adult GH deficiency (AGHD) determine its significance as a disease associated with increased cardiovascular risk. However, recent contradictory data about the long-term beneficial effects of GH replacement, especially on cardiovascular risk, provoked some further analysis of its contributory factors.

Aim of the study: To identify the individual risk factors of metabolic syndrome (MS) in AGHD and to compare the prevalence and the characteristics of MS in a cohort of GHD patients with age- and sex-adjusted control group.

Material and methods: Individual risk factors of MS were evaluated in 54 adult patients with GHD (COGHD: n=19, AOGHD: n=35) and in age- and sex-adjusted control group of 2153 subjects participating in Bulgarian population-based study of thyroid diseases and diabetes mellitus. GHD was diagnosed according to the Endocrine Society Clinical Practice Guideline recommendations from 2011 and MS was scored by the NCEP-ATP III definition.

Results: The main metabolic abnormalities in GHD group were increased waist circumference (50.0%), low HDL-cholesterol (42.6%) and hypertriglyceridemia (40.7%). Moreover, their prevalence was significantly higher than in control group (P=0.013, P=0.019, and P=0.010 respectively). Only the prevalence of increased blood pressure was significantly higher in control group (P<0.0001). However, the difference in MS prevalence among GHD patients (29.6%) and control subjects (24.9%) failed to reach statistical significance (P=0.429). Among patients in both groups, already diagnosed with MS, increased blood pressure was the only component which prevalence remained significantly different (P=0.002).

Conclusion: AGHD is associated with the development of visceral obesity and dyslipidemia. Nevertheless, these adverse cardiovascular risk factors did not determine a higher prevalence of metabolic syndrome in GHD patients compared to control subjects. These results, as well as recent controversial data about long-term effects of GH replacement therapy on cardiovascular risk, face endocrinologists with the necessity of strict selection of patients initiating GH substitution and of the appropriate duration of this treatment.