Growth Hormone for Survival: It's not always controversial

"Hypopituitary adults have a reduced life expectancy, with a 2-fold higher risk of death for cardiovascular disease compared with that in the control population, and [growth hormone deficiency] has been considered the underlying factor influencing this increased mortality."

Lately growth hormone has been given a bad rap because of the controversy of its abuse by healthy, adult athletes and body-builders. That's actually very sad when there is a sizable body of chronically afflicted, growth hormone deficient adults. Hypopitiutarism and panhypopituitarism due to pituitary adenomas, surgery as treatment, and/or infarction leaves most Cushing's Disease survivors with growth hormone deficiency (GHD).

According to recent research, quoted here at Stanford and reiterated by Dr. Theodore Friedman, "GH appears to be one of the first hormones to be lost in patients with pituitary tumors and nearly all patients with two or more other pituitary deficiencies also lack GH."

In a recent issue of Pituitary, a study titled "Effects of 5 years of growth hormone (GH) replacement therapy of cardiac parameters and physical performance in adults with GH deficiency" caught my eye. Although not really news to me, it was nice to see some more validation. The research is outlined exceptionally well, with concise but thorough discussion and analysis.

The bottom line: There may be a slight increase in blood pressure and left ventricular mass with treatment, but this is greatly offset by "positive effects on exercise capacity and maximum oxygen uptake".

Another study states:

...there is no doubt that adult patients with hypopituitarism and GH deficiency have an increased CV risk (odds ratio of 2 for men and 3.5 to 4 for women). "

Improvement of systolic and diastolic pressures, lipid profiles, and plaque formation are also documented. A significant decrease in IMT and CRP were favorable outcomes of GH replacement therapy.

GHD has also been linked to apathy, fatigue, lack of motivation and more. Thus, it becomes not only an issue of mortality, but also an issue of quality of life.

I hope the medical community will educate themselves about GHD. The authors of the Pituitary
study elaborated well:

GHD is associated with hypercoagulability, abdominal obesity, insulin resistance, unfavorable lipid profile, atherosclerosis, increased blood pressure (BP), decreased exercise performance and with reduced pulmonary capacity, left ventricular (LV) mass and LV systolic performance...

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Cenci, M., Soares, D., Spina, L., Lima Oliveira Brasil, R., Lobo, P., Mansur, V., Gold, J., Michmacher, E., Vaisman, M., & Conceição, F. (2009). Effects of 5 years of growth hormone (GH) replacement therapy on cardiac parameters and physical performance in adults with GH deficiency Pituitary DOI: 10.1007/s11102-009-0182-2

The Cardiovascular Risks of Growth Hormone Deficient Adults

The Importance of Replacement Therapy

I have growth hormone deficiency (GHD) and other pituitary hormone deficiencies due to a pituitary tumor. My surgery to remove the tumor did not help any, and when I had the Arginine GH stimulation test this past spring, I did not produce nearly enough GH. GH is pulsatile and needs stimulation in order to be tested correctly. IGF-1 is not a reliable marker of GH production.

Low GH has been tied to depression and apathy. It is also linked to cardivascular risks. In Cardiovascular Risk in Patients with Growth Hormone Deficiency: Effects of Growth Hormone Substitution (free access), the authors state:

The increased CV risk in overweight patients is particularly dependent on a high proportion of abdominal (visceral) fat in comparison with total body fat.[8-12] Insulin resistance (IR), increased inflammatory markers, and microvascular and macrovascular disease are common complications. Patients with GH deficiency demonstrate a high prevalence of obesity and share most of the risk factors of those with simple obesity. Blood pressure, however, is not necessarily increased in patients with GH deficiency.

Nonobese and even lean patients with GH deficiency have a high ratio of abdominal to total body fat.[5,11] They are at a higher CV risk than an age- and weight-matched population. It is recognized that these subjects have a lean body mass deficit of approximately 3 to 4 kg and an increase of 1 to 2 kg in abdominal fat. This pattern is frequently observed in women with panhypopituitarism but is also seen in men.[8]

The article concludes "there is no doubt that adult patients with hypopituitarism and GH deficiency have an increased CV risk (odds ratio of 2 for men and 3.5 to 4 for women). " Improvement of systolic and diastolic pressures, lipid profiles, and plaque formation are also documented. A significant decrease in IMT and CRP were also favorable outcomes of GH replacement therapy.

To read more:

Testing 101: Testing Growth Hormone Levels in Adults

Arginine GHRH stimulation test

Cardiovascular Risk in Patients with Growth Hormone Deficiency: Effects of Growth Hormone Substitution
Albert G. Burger, MD;1 John P. Monson, MD;2 Anna M. Colao, MD;3 Anne Klibanski, MD4
Endocr Pract. 2006;12(6):682-689. ©2006 American Association of Clinical Endocrinologists
Posted 04/11/2007