ESPE Abstracts

There is still controversy about body composition after completion of growth hormone (GH) therapy in patients with GHD once final adult height has been reached.

Objective: A cross-sectional study was conducted to evaluate body composition in males after GH therapy discontinuation, during the transition stage.

Patients and Methods: 18 males with confirmation of persistent GHD (16.7-21.5 years) after GH discontinuation were evaluated; 14/18 with multiple pituitary hormone deficiency, all of them with adequate replacement. We assessed body mass index (BMI), IGF1 (SDS), body composition (by whole-body densitometry, GE Lunar Prodigy Advance®, Software 18 SP 3), fat mass (FM), lean mass (LM) and bone mineral content (BMC). FM distribution and BMC/LM ratio were also analyzed in relation to time since GH discontinuation and IGF1 levels. Correlations were evaluated using the Spearman test.

Results: (median and range) the time since GH discontinuation was 2.2 (0.1-6.5) years and IGF1 levels (SDS) were: -3.03 (-7.5 to -1.8). Based on BMI, 8 patients were normal weight, 5 were overweight and 5 were obese. FM percentage was 38.4 (19.4-49.5), LM percentage was 59.3 (49.1-77.0) and BMC was 3.10 (2.11-4.84). Some discrepancies were found between normal BMI and increased FM in 22% of patients: 4 cases with normal BMI and increased FM (3 of them with abdominal distribution). BMC/LM (g/Kg) was: 55.6 (41.8-64). Increased FM was found in 14/18 cases with abdominal distribution in 10; LM index was decreased in most cases. IGF1 levels did not show correlation with any of the variables assessed. The time since GH discontinuation showed a negative correlation with LM percentage (r: -0.49, p: 0.037) and a positive correlation with BMI (r: 0.65, p: 0.003).

Conclusion: 1-Our results show significant abnormalities in body composition in males during the transition period, mainly increased FM with predominant central distribution and decreased LM. The negative effect on muscle mass, which is more pronounced the longer the time elapsed since GH discontinuation, might affect bone structure in a time-dependent manner. 2-Our findings appear to suggest that, during this stage, BMI might not reflect the degree of obesity in all cases; therefore, the use of this parameter for cardiometabolic risk assessment might have limitations. 3-Finally, in agreement with previous studies, our findings support maintenance of GH therapy to avoid an impairment of body composition in these patients.