Abnormal body composition and reduced bone mass in growth hormone deficient hypopituitary adults

The role of growth hormone in maintaining normal body composition and bone strength in adults has attracted much interest recently. We have assessed body composition and bone mass in GH deficient hypopituitary adults on conventional replacement therapy and compared them with matched controls.

A cross-sectional study of 64 growth hormone deficient hypopituitary adults (29 males and 35 females) on conventional replacement therapy and a large number of healthy control subjects matched for age, sex and body mass index (BMI).

Skinfold thicknesses at two sites (triceps and subscapular), waist and hip girth circumferences were assessed by standard methods. Body composition was assessed using total body potassium (TBK), bioelectrical impedance analysis (BIA) and dual-energy X-ray absorptiometry (DEXA). Bone mineral mass was assessed at the lumbar spine and the total body by DEXA. Not every patient and control participated in every measurement.

Obesity was common in the hypopituitary patients; BMI (mean +/- SD) was 27.5 +/- 4.6 kg/m2 and body weight was 111.8 +/- 18.5% of the maximal ideal for height (P < 0.001). The sum of subscapular and triceps skinfolds was significantly higher in hypopituitary patients than in controls (men 46 + 15 vs 37 +/- 14 mm, P < 0.05; women 55 +/- 13 vs 47 +/- 17 mm, P < 0.05). Waist to hip circumference ratio was significantly greater in female hypopituitary patients than in matched controls but was not significantly different in men (men 0.94 +/- 0.07 vs 0.91 +/- 0.07, NS; women 0.84 +/- 0.09 vs 0.77 +/- 0.05, P < 0.001). The difference between patients and controls in the sum of skinfolds and the waist to hip ratio were present in non-obese (BMI < 26 kg/m2) subjects (21 patients and 32 controls). TBK corrected for body weight was significantly lower in hypopituitary patients (n = 44) than in controls (n = 31) (men 43.5 +/- 5.6 vs 50.1 +/- 5.9 mmol/kg, P < 0.003; women: 34.0 +/- 3.2 vs 40.6 +/- 5.3 mmol/kg, P < 0.0001). BIA-derived body water content (corrected for body weight) was significantly lower in hypopituitary patients (n = 56) than in controls (n = 57) (0.492 +/- 0.064 vs 0.545 +/- 0.067 l/kg, P < 0.0004). Percentage body fat derived from all the three methods was significantly higher in hypopituitary patients than in normal controls in both sexes (from TBK: men 34.7 +/- 9.4 vs 28.8 +/- 7.0%, P < 0.05; women 37.8 +/- 8.7 vs 30.4 +/- 9.7%, P < 0.01; from BIA: men 29.3 +/- 8.5 vs 23.2 +/- 8.4%, P < 0.01; women 34.6 +/- 8.1 vs 29.3 +/- 9.1% P < 0.01; and from DEXA: men 24.8 +/- 6.8 vs 20.4 +/- 6.1%, P < 0.05; women 38.9 +/- 7.9 vs 32.5 +/- 9.8%, P < 0.01). There was a significant difference between non-obese patients and controls in BIA-derived percentage fat in both sexes and in TBK-derived percentage fat in females only. Bone mineral density (BMD) of the lumbar spine in the L2-L4 region was lower in hypopituitary patients than in controls (men 1.116 +/- 0.129 vs 1.311 +/- 0.131 g/cm2, P < 0.0001; women 1.001 +/- 0.122 vs 1.131 +/- 0.138 g/cm2, P < 0.001). Spine BMD was also reduced in hypopituitary patients compared to the young adult and age and weight matched reference data. Total body BMD was significantly lower in patients than in controls (men 1.186 +/- 0.102 vs 1.250 +/- 0.080 g/cm2, P < 0.05; women 1.080 +/- 0.077 vs 1.149 +/- 0.073 g/cm2, P < 0.005).

Hypopituitary adults on conventional therapy have abnormal body composition with increased fat content, reduced body water content and reduced bone mineral mass.