Background: Growth hormone treatment (GH) in children with PWS results in an improvement in height velocity, body composition and mental and motor development. Discontinuation of GH after attainment of adult height (AH) leads to a decrease in lean body mass and an increase in body fat percentage, which results in an increased risk of impaired glucose tolerance (IGT) and diabetes mellitus type 2 (DM2). Studies in adults with PWS suggest positive effects of GH, but GH is known to induce insulin resistance. Reports on the prevalence of DM2 vary from 7-50% in adults with PWS.
Objective and hypotheses: To evaluate the effects of GH on glucose metabolism in young adults with PWS who were treated with GH during childhood and recommenced GH in adulthood. Hypothesis: GH lowers insulin sensitivity, but does not significantly alter glucose tolerance.
Method: In this prospective study 15 patients with PWS (15-20 years) recommenced Somatotropin in a dose of 0.33 mg/m2 per day, after discontinuation for a median duration of 4 months at attainment of AH. Fat Mass, Lean Body Mass, weight, waist and hip circumference, blood pressure, IGF-I, IGF-BP3 and OGTT were collected at baseline and yearly thereafter.
Results: There was a significant increase in baseline insulin and HOMA-IR after 2 years of GH (P=0.011 and 0.019, respectively), but baseline glucose, glucose and insulin 2 h after glucose load and glucose AUC did not significantly change. One patient had IGT before start of GH and two patients developed IGT during 2 years of GH. None developed DM2.
Conclusion: Two years of GH in young adults with PWS leads to lower insulin sensitivity without significant changes in glucose levels. Two patients developed IGT during 2 years of GH treatment, but none developed DM2. Thus, GH does influence insulin sensitivity, but did not lead to the development of diabetes in our group of young adults with PWS.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology