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Published on: May 10, 2018
Correlation between adrenal function, growth hormone secretion, and insulin sensitivity in children with idiopathic
A Ciresi1, S Radellini1, E Vigneri1
1Section of Endocrinology, Diabetology and Metabolic Diseases, Biomedical Department of Internal and Specialist Medicine (DIBIMIS), University of Palermo, Piazza delle Cliniche 2, 90127, Palermo, Italy.
Insights
Growth hormone deficiency (GHD) in children is linked to altered cortisol metabolism and metabolic issues. Growth hormone treatment (GHT) improves metabolism, with cortisol levels correlating with GH secretion and metabolic parameters.
Area of Science:
- Pediatric Endocrinology
- Metabolic Disorders
- Hormone Therapy
Background:
- Growth hormone deficiency (GHD) is associated with an elevated cortisol/cortisone ratio, potentially explaining metabolic disturbances.
- Growth hormone treatment (GHT) may influence cortisol metabolism.
Purpose of the Study:
- To investigate adrenal function and cortisol metabolism in children with GHD.
- To assess the impact of GHT on cortisol levels and metabolic parameters.
Main Methods:
- Evaluated 35 children with GHD and 25 controls.
- Assessed adrenal function via morning serum cortisol, cortisol peak, and AUC during insulin tolerance test (ITT).
- Monitored metabolic parameters, including glucose and lipid profiles, before and after 12 months of GHT.
Main Results:
- GHD children exhibited higher morning cortisol and Homa-IR, with lower fasting glucose and ISI-Matsuda compared to controls.
- Morning cortisol, peak cortisol, and AUC were negatively correlated with GH levels and ISI-Matsuda.
- After 12 months of GHT, significant improvements were observed in fasting glucose, Homa-IR, and lipid profiles, accompanied by a decrease in morning cortisol and AUC.
Conclusions:
- Cortisol levels in children with GHD correlate with GH secretion and various metabolic parameters.
- The metabolic benefits of GHT are primarily attributed to the treatment itself, rather than solely to cortisol reduction.
Purpose:
Patients with growth hormone deficiency (GHD) demonstrate an increased cortisol/cortisone ratio which could potentially explain the metabolic features of GHD, while GH treatment (GHT) could increase the cortisol metabolism.
Methods:
In 35 children (27 M, mean age 10.1 years) with idiopathic GHD at baseline and after 12 months of GHT and in 25 controls, in addition to metabolic parameters, we assessed adrenal function by morning serum cortisol, its peak, and its area under the curve (AUCCOR) during insulin tolerance test (ITT).
Results:
A cortisol peak <18 µg/dl was shown in 22 and 31% of GHD children at baseline and after GHT, respectively. At baseline, GHD children had lower fasting glucose (p < 0.001) and ISI-Matsuda (p = 0.042), with concomitant higher Homa-IR (p = 0.006) and morning cortisol (p = 0.012) than controls. Morning cortisol was negatively correlated with GH (p < 0.001), fasting glucose (p < 0.001) and ISI-Matsuda (p < 0.001) and positively with Homa-IR (p = 0.010). Both cortisol peak and AUCCOR were negatively correlated with GH (all p < 0.001) and ISI-Matsuda (p = 0.016 and p = 0.001, respectively). After 12 months of GHT, a significant increase in fasting glucose (p < 0.001), and Homa-IR (p = 0.011) was documented, with a concomitant decrease in morning cortisol (p = 0.002), AUCCOR (p = 0.038), total (p = 0.003) and LDL-cholesterol (p = 0.016). No significant correlations were found among cortisol levels and all parameters were investigated.
Conclusions:
Cortisol levels correlate with GH secretion and with many metabolic parameters in GHD children, while the metabolic effects during GHT are mainly due to GHT per se and less to cortisol reduction.
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