Cambridge University Article Abstract on Human Growth Hormone (hGH)
Christiansen, Jens Sandahl;Vahl, Nina. Medical Department M, Aarhus University Hospital, Aarhus C, Den. Editor(s): Juul, Anders; Joergensen, Jens Otto Lunde. Growth Horm. Adults (2nd Ed.) (2000), 222-232. Publisher: Cambridge University Press, Cambridge, UK CODEN: 69ACML Conference; General Review written in English. CAN 133:217745 AN 2000:445371 CAPLUS (Copyright 2001 ACS)
Abstract
A review with approx. 50 refs. on the know effects of GH on muscle and fat mass. GHD in adults is assocd. with abnormal av. body compn., characterized by an increase in adipose tissue mass and a decrease in muscle mass. These changes are the logical results of the metabolic abnormalities which characterize the GHD syndrome. The abnormal body compn. is assoc. with insulin resistance. Long-term GH replacement therapy normalizes body composition and also seems to have a favorable influence upon insulin resistance.
Introduction
The anabolic and lipolytic effects of growth hormone (GH) and thereby the effects upon muscle and fat tissue have been known for many years. The effects on body composition should, however, not be seen as an isolated phenomenon, but rather as the integrated results of the well documented metabolic actions of GH – described elsewhere in this volume. Furthermore, there exists a rather complex relationship between ageing, body composition and GH secretion, which is important to take into consideration in the diagnostic process in elderly patients suspected for GH deficiency (GHD).
Relation between body composition, age and GH secretion
Spontaneous as well as stimulated GH secretion declines with age (Vahl et al., 1996, 1997a). This decline in GH secretion seems to be closely related to indices of adiposity and physical fitness. Thus physical fitness correlates positively with peak GH levels after stimulation as well as with estimates of spontaneous GH secretion (Vahl et al., 1997a). Even more impressive, however, is the very close correlation between intra-abdominal fat and a reduction in both stimulated and spontaneous GH secretion (Vahl et al., 1997a). Abdominal adiposity is also associated with an increased turnover of lipids resulting in higher levels of non-esterified fatty acids in plasma, which have been shown to inhibit GH secretion (Imaki et al., 1985).
Effects of GH replacement in adults
The two first placebo controlled studies in adults on the effects of GH replacement therapy upon psychological and physiological features-including body composition - were reported in 1989. Since then numerous independent studies have been published deriving from controlled as well as uncontrolled trials – and an even larger number of studiues are still in progress worldwide. Despite the fact that the GH-deficient patients included in these different studies differ considerably with regard to age, whether or not multiple pituitary hormone insufficiency was present and whether GHD was of childhood or adult onset, and despite the huge variability of methods employed, the results are remarkably similar. Using CT scan and skinfold measurements, Jorgensen et al. (1989) reported on a group of young adults with previously treated childhood onset GHD, where GH treatment for four months resulted in a significant increase in muscle mass and a concomitant decrease in fat mass as compared to placebo treatment. Initial muscle: fat ratio increased from 64.0:36.0 to 66.7:33.3 during the four months of treatment, with a further increase to 72.6:27.4 after more than one year of treatment in an open designed, follow-up study.
Conclusion
GHD in adults is associated with abnormal average body composition, characterized by an increase in adipose tissue mass and a decrease in muscle mass. These changes are the logical results of the metabolic abnormalities which characterize the GHD syndrome.
The abnormal body composition is associated with insulin resistance (Salomon et al., 1992; Fowelin et al., 1993) and decreased muscle strength (Cuneo et al.,1990; Rutherford, Beshyah & Johnston, 1994).
Long-term GH replacement therapy normalizes body composition, and also seem to have a favorable influence upon insulin resistance (Feldmeier et al., 1997).
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