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Metabolic consequences of GH deficiency
J O L Jørgensen1, E Vestergaard, L Gormsen
1Medical Department and Institute of Experimental Clinical Research, Aarhus University Hospital, Aarhus, Denmark. jolj@dadlnet.dk
Journal of Endocrinological Investigation
|August 24, 2005
Summary
Growth hormone (GH) resistance in acromegaly and deficiency states may stem from free fatty acid flux. Evening GH administration and tailored dosing can manage metabolic side effects like hyperglycemia.
Area of Science:
- Endocrinology
- Metabolic Research
- Hormone Therapy
Background:
- Acromegaly patients exhibit insulin resistance and glucose intolerance.
- Growth hormone (GH) deficiency in children leads to insulin sensitivity and potential hypoglycemia.
- Adults with untreated GH deficiency paradoxically show insulin resistance, which can worsen with GH therapy.
Purpose of the Study:
- To explore a unifying mechanism for insulin resistance in acromegaly and GH deficiency.
- To investigate the role of free fatty acids (FFA) and lipid oxidation in GH-related metabolic changes.
- To identify optimal strategies for managing metabolic side effects during GH substitution therapy.
Main Methods:
- Analysis of metabolic profiles in patients with acromegaly and GH deficiency.
- Assessment of insulin sensitivity, glucose tolerance, and FFA flux.
- Evaluation of lipid oxidation and protein conservation during fasting and GH administration.
- Review of clinical outcomes with different GH administration protocols.
Main Results:
- Increased FFA flux due to visceral obesity (untreated GH deficiency) and enhanced lipid oxidation (GH substitution) are proposed unifying mechanisms for insulin resistance.
- GH-induced insulin resistance during fasting may be a favorable adaptation, promoting lipid oxidation and protein conservation.
- Elevated circadian GH levels from non-fasting administration can lead to hyperglycemia, while insulin therapy may cause hypoglycemia.
Conclusions:
- Evening administration of GH and individualized dosing are recommended to mitigate adverse metabolic effects.
- Careful patient monitoring is crucial to minimize hypoglycemia from insulin therapy and hyperglycemia from GH substitution.
- Long-term benefits of GH on body composition may counterbalance its insulin-antagonistic effects on glucose metabolism.
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