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Endocrine Abstracts (2015) 37 GP20.02 | DOI: 10.1530/endoabs.37.GP.20.02

ECE2015 Guided Posters Pituitary – Hypopituitarism (9 abstracts)

Association of serum IGF1 concentration with cardiovascular function in adults with GH deficiency with different GH treatment regimes: a randomised clinical trial

Christa C van Bunderen 1 , Rick I Meijer 2 , Paul Lips 1 , Mark H Kramer 3 , Erik H Serné 2 & Madeleine L Drent 1


1Department of Internal Medicine, section Endocrinology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands; 2Department of Internal Medicine, Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands; 3Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands.


Objective: Epidemiological evidence for a link between serum IGF1 concentration and cardiovascular disease in the general population and in patients with GH deficiency or hypersecretion has been demonstrated. However, the underlying mechanisms remain unresolved. We investigated associations between IGF1 levels within the reference range and different measures of cardiovascular function and risk factors in substituted GH deficient adults within a randomized clinical trial.

Methods: Thirty-two subjects receiving GH therapy for at least a year with a stable IGF1 concentration of -1 to 1 SDS were included and randomised to receive either a decrease of their regular dose (IGF1 target level: -2 to -1 SDS) or an increase of their dose (IGF1 target level: 1 to 2 SDS) for a period of 6 months. Measurements of micro- and macrovascular function, lipid profile, inflammation, and insulin resistance (HOMA-IR) were performed.

Results: Thirty subjects (65.6% male, mean age 46.6 (9.9 S.D.) years) could be analysed. A relationship with vasomotion of skin microvasculatory blood flow measured by skin laser Doppler flowmetry seemed evident. Decreasing GH dose led to a decrease in energy contribution from the local endothelial activity (Δ -0.27 (0.42 S.D.), P=0.03), which was significantly different from increasing GH dose (P=0.03). There was a trend for a difference between de- and increasing GH dose in the augmentation index during pulse wave analysis in favour of a high-normal IGF1 level (P=0.06). Decreasing the GH dose led to an increase in hs-CRP (Δ 1.49 mg/l (3.84 S.D.), P=0.03), which was significantly different from increasing GH dose (P=0.04). Increasing the GH dose led to an increase in HOMA-IR (Δ 0.38 (0.52 S.D.), P=0.01), which was significantly different from decreasing GH dose (P=0.01).

Conclusions: IGF1 level within the reference range in GH treated adults is related to microvascular endothelial activity, inflammation, and metabolic insulin resistance.

Disclosure: C C van Bunderen is supported by an AGIKO grant of The Netherlands Organisation for Health Research and Development (ZonMw) (grant number: 92003591). This work was partly supported by an investigator-initiated grant from Pfizer bv.

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