| The diagnosis of GH deficiency in obese patients: a reappraisal with GHRH plus arginine testing after pharmacological blockade of lipolysis. | |
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MedLine Citation:
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PMID: 20460421 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The diagnosis of GH deficiency (GHD) in obese patients is complicated by the reduced GH secretion associated with overweight. A GH response to GHRH+arginine lower than 4.2 microg/l is currently considered indicative of GHD in obesity. The aim of the study was to investigate the effect of acute pharmacological blockade of lipolysis on the GH response to GHRH+arginine in obese patients. PATIENTS AND METHODS: Two groups of patients were studied: 12 obese patients with proven GHD and 14 patients with essential obesity. On separate occasions, two tests were carried out in each patient: GHRH+arginine and GHRH+arginine preceded by acipimox. RESULTS: The mean GH peak after GHRH+arginine was significantly lower in hypopituitary patients than in subjects with essential obesity. Acipimox significantly increased the mean GH response in patients with essential obesity, but not in hypopituitary subjects. All hypopituitary patients and 7/14 patients with essential obesity displayed GH peaks lower than 4.2 microg/l after GHRH+arginine: the GH response to the test increased after acipimox pretreatment in five of these seven essentially obese subjects. After acipimox administration, free fatty acids (FFAs) significantly fell in both groups with comparable mean absolute decreases. All IGF1 values were normal in both groups of subjects. CONCLUSIONS: Our study has demonstrated that the acipimox-induced acute reduction of circulating FFA levels increases mean somatotropin response to GHRH+arginine in patients with essential obesity, whereas it has no effect in hypopituitary subjects. The current criterion for the diagnosis of GHD in obese patients may be misleading. Indeed, subjects affected by third degree obesity, like most of our patients, may be erroneously classified as really GH-deficient and started on an expensive unjustified treatment. It appears therefore that the current criteria for the diagnosis of GHD in obesity should be reconsidered in the light of further studies also taking into account different body mass index groups. |
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Authors:
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Massimo Scacchi; Federica Orsini; Agnese Cattaneo; Alice Grasso; Barbara Filippini; Francesca Pecori Giraldi; Letizia Maria Fatti; Mirella Moro; Francesco Cavagnini |
Publication Detail:
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Type: Journal Article Date: 2010-05-11 |
Journal Detail:
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Title: European journal of endocrinology / European Federation of Endocrine Societies Volume: 163 ISSN: 1479-683X ISO Abbreviation: Eur. J. Endocrinol. Publication Date: 2010 Aug |
Date Detail:
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Created Date: 2010-07-27 Completed Date: 2010-08-17 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9423848 Medline TA: Eur J Endocrinol Country: England |
Other Details:
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Languages: eng Pagination: 201-6 Citation Subset: IM |
Affiliation:
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Division of Endocrinology and Metabolic Diseases, Università degli Studi di Milano, Ospedale San Luca IRCCS, Milano, Italy. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Antilipemic Agents / pharmacology Arginine / diagnostic use* Female Growth Hormone-Releasing Hormone / diagnostic use* Human Growth Hormone / deficiency* Humans Hypopituitarism / blood, complications, diagnosis* Insulin / blood Insulin-Like Growth Factor I / metabolism Linear Models Lipolysis / drug effects* Male Middle Aged Obesity / blood, complications* Pyrazines / pharmacology |
| Chemical | |
Reg. No./Substance:
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0/Antilipemic Agents; 0/Pyrazines; 11061-68-0/Insulin; 12629-01-5/Human Growth Hormone; 51037-30-0/acipimox; 67763-96-6/Insulin-Like Growth Factor I; 74-79-3/Arginine; 9034-39-3/Growth Hormone-Releasing Hormone |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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