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Metabolic phenotype of adults with GH deficiency different between United States, Europe

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The prevalence of metabolic syndrome in adults with growth hormone deficiency was higher than in the general population in the United States, and higher in the United States than in Europe, according to a recent study.

Researchers assessed 2,531 GH-deficient adults enrolled in the Hypopituitary Control and Complications Study.

At baseline, the crude prevalence of metabolic syndrome in the total cohort was 42.3%. The age-adjusted prevalence of metabolic syndrome was significantly higher in the United States (51.8%) compared with Europe (28.6%; P<.001). Further, in the United States, the age-adjusted prevalence was significantly higher compared with a general population survey (P<.001).

Adults aged 40 years and older had an increased metabolic syndrome risk at baseline (RR=1.34; 95% CI, 1.17-1.53), as well as women (RR=1.15; 95% CI, 1.05-1.25) and those with adult-onset GH deficiency (RR=1.77; 95% CI, 1.44-2.18).

GH replacement did not appear to alter the presence of metabolic syndrome, according to the researchers. After three years of treatment, metabolic syndrome prevalence remain unchanged in GH-treated adult-onset patients (42.5%-45.7%; P=.172). Noteworthy changes were observed in waist circumference (62.1%-56.9%; P=.008), fasting glucose (26%-32.4%; P<.001) and blood pressure (59.8%-69.7%; P<.001).

Baseline metabolic status and obesity were determined to be strong predictors of metabolic syndrome after GH replacement, according to the researchers. A significant increased risk for metabolic syndrome at year three was linked to baseline metabolic syndrome (adjusted RR=4.09; 95% CI, 3.02-5.53), BMI >30 (RR=1.53; 95% CI, 1.17-1.99) and increased risk for GH dose of >600 mcg per day (RR=1.18; 95% CI, 0.98-1.44).

“Despite GH replacement, the prevalence of metabolic syndrome remained unchanged in the treated cohort, suggesting that GH intervention alone cannot affect metabolic syndrome-associated risk if other non-GH deficiency factors contribute to it,” the researchers wrote. “The data confirm that aggressive treatment of these non-GH deficiency related aspects may be required for measurable metabolic benefits of GH replacement to be achieved.”

Attanasio A. J Clin Endocrinol Metab. 2009;95:74-81.