Jørgensen JOL, Thiesen L. Müller J, Ovesem P, Skakkebæk NE, Christiansen JS. Three years of growth hormone treatment in growth hormone-deficient adults: near normalization of body composition and physical performance. Eur J Endocrinol 1994;130:224-8. ISSN 0804-4643

Growth hormone (GH) replacement therapy in several controlled short-term trials have shown unanimous beneficial effects on body composition and other features. To evaluate more long-term effects we report data from 3 years of uninterrupted GH therapy in 10 different GH-Deficient adults who had all months of open GH therapy. No further increase in linear height was observed. The initial increase in thigh muscle volume was recorded. Exercise capacity and isometric muscle strength were increased significantly compared to the initial placebo period. This was associated with stabilized levels of resting heart rate and blood pressure. Glycosylated hemoglobin levels were normal and did not change during the study. A standard oral glucose tolerance test performed at the end of the study revealed no evidence of glucose intolerance. No side-effects were reported. Compared to an age- and sex-matched group of healthy untreated subjects, thigh muscle volume, exercise capacity and isometric muscle strength had become normalized from subnormal levels after 3 years of GH therapy.

We conclude that long-term GH replacement therapy in GH-deficient adults is associated with preserved beneficial effects on body composition and physical performance, resulting in a near normalization of several previously abnormal features and adding new merits to this treatment modality.

Jens OL Jørgensen, Medical Department M (Endocrinology and Diabetes), Aarhus Kommunehospital, DK-8000C, Denmark

Within the last 4 years several studies on growth hormone (GH) treatment in GH-deficient adults have been published (1, 2). This in turn has prompted surveys on epidemiological and clinical features of hypopituitary adults (3-9). It has become evident that untreated GH deficiency in adulthood is associated with abnormal body composition in terms of increased fat mass (4, 5, 7, 9), decreased lean body mass (5, 8), decreased extracellular water (5, 7, 9) and decreased bone mineral content (4, 6). In addition, there is suggestive evidence of a substantially increased mortality in these patients due to cardiovascular disease (3, 4). Growth hormone treatment in adult patients has shown unequivocal beneficial effects as regards part normalization of body composition (10-16). Furthermore, GH therapy has been shown to improve exercise capacity (10, 12, 14, 16, 17) and muscle strength (12, 18) from distinctly subnormal levels. Additional potentially beneficial effects of GH therapy on several other features also have been reported (10, 11, 13, 15, 19-24). So far, the only substantial side-effect has been subjective discomfort related to fluid retention, which in most instance is a transient dose-dependent occurrence. Still, the well-known insulin antagonistic actions of GH may cause concern.

The duration of GH therapy in presently published trials has not exceeded 16 months. Therefore, we have found it relevant to report in this paper the data on 3 years of uninterrupted GH therapy in GH-deficient adults.