ESPE Abstracts

Aims: The aim of the study is to evaluate body composition and microcirculation in children and adolescents with growth hormone deficiency (GHD) and the effects of replacement therapy. These parameters were also evaluated in children and adolescents with suspected GH deficiency but in whom drug stimulus testing was later found to be normal.

Materials and Methods: We examined 44 patients (25 males and 19 females) aged between 6 and 16 years who underwent pharmacological testing to evaluate the presence of GHD. Of these 44 subjects, 26 were found to have growth hormone (GH) deficiency, while in the remaining 18 the test excluded the presence of deficiency (not-GHD). In each subject we evaluated body mass index (BMI), fat mass, fat free mass and total body water using Bioelectrical impedance analysis (BIA) and endothelial function using PeriFlux.v12. Patients were then re-evaluated after 6 months repeating the same measurements: 6 GHD in therapy and 6 subjects not in therapy (of which 2 GHD and 4 not-GHD).

Results: As far as body composition is concerned, no statistically significant differences were found at the first evaluation (T0) between GHD and not-GHD patients. In the 6 patients with GHD on therapy, at the 6-month re-evaluation (T1) were detected a reduction in fat mass (FM), an increase in lean mass (FFM) and an increase in total body water (TBW). These changes were not found in the 6 patients not on therapy. Post-occlusive hyperemia (PORH) detected at Periflux gave instead as average value at T0 in GHD subjects 210.9 ± 63.4 perfusion units/second, while in not-GHD subjects 287.8 ± 106.6 perfusion unit/second. The difference is statistically significant (P=0.01). Using PORH as a parameter of endothelial function, GHD patients seem to have a greater degree of dysfunction than not-GHD patients.

Conclusions: Since obese patients have been shown to have lower GH levels and respond less to drug-stimulus tests, that the dosage of GH therapy should consider lean body mass and that GH therapy modifies body composition we believe it is important to evaluate the body composition of these patients. The greater degree of endothelial dysfunction found in GHD patients compared to non-GHD patients could contribute to an increase in the cardiovascular risk, a further aspect that would underline the importance of replacement therapy and to evaluate the need to continue it even once the definitive height has been reached in adulthood in case of persistence of GHD.