Pinaki Dutta, Bhuvanesh Mahendran, K S Reddy, Jasmina Ahluwalia, Kim Vaiphei, R K Kochhar, Prakamya Gupta, Anand Srinivasan, Mahesh Kumar, Kanchan K Mukherjee, Viral N Shah, Girish Parthan and Anil Bhansali

Endocrinology, PGIMER, Chandigarh, 160012, India.

Abstract

Introduction: The effectiveness and short-term safety of recombinant human growth hormone (r-hGH) in patients with acromegaly who develop growth hormone deficiency (GHD) after treatment, is not well established.

Subjects and Methods: Ten subjects with acromegaly who had GHD were treated with r-hGH for six months. Control groups consisted of ten age, gender and body mass index matched healthy subjects and ten active acromegaly patients who were treatment naïve. Body composition, quality of life, muscle strength, lipid profile and cardiovascular risk factors were assessed in all subjects at baseline, and the same parameters were reassessed after 6 months of therapy with r-hGH in acromegaly with GHD. Repeat MRI of the sella was performed in treated subjects. Optical colonoscopy was done and biopsies were taken from multiple sites for proliferation indices (Ki-67).

Result: The median duration of GHD was 17.8 months and dose of r-hGH administered was 5.7±1.5 µg/kg/d. There was improvement in bone mineral content (p 0.01), bone mineral density (p 0.04), muscle strength (p<0.001), total cholesterol (p 0.003), high density cholesterol (p<0.001) and Quality of Life -Score (p 0.005) with reduction in low density cholesterol (p 0.003) and triglyceride (p 0.004) after treatment. There was no change in lean body mass, total body fat, hsCRP, lipoprotein (a) and fibrinogen levels. There was a modest increase in plasminogen activator inhibitor -1(PAI-1) (p 0.002), but it was lower compared to healthy controls and treatment naïve acromegalics (p 0.007).

Conclusion: Six months of r-hGH therapy improves body composition, atherogenic lipid profile, quality of life, muscle strength in GHD patients who had acromegaly. Long term prospective studies are needed to evaluate the effect of r-hGH therapy in these patients.