Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Prevalence and risk factors of the metabolic syndrome in young adults with childhood-onset hypopituitary growth hormone deficiency

  • Lim, Han-Hyuk (Department of Pediatrics, School of Medicine, Chungnam National University) ;
  • Kang, Min-Jae (Department of Pediatrics, College of Medicine, Seoul National University) ;
  • Yun, In-Suk (Department of Pediatrics, Gumdan Top General Hospital) ;
  • Lee, Young-Ah (Department of Pediatrics, College of Medicine, Seoul National University) ;
  • Shin, Choong-Ho (Department of Pediatrics, College of Medicine, Seoul National University) ;
  • Yang, Sei-Won (Department of Pediatrics, College of Medicine, Seoul National University)
  • Received : 2010.07.15
  • Accepted : 2010.09.08
  • Published : 2010.10.15
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Abstract

Purpose: This study evaluated the prevalence of the metabolic syndrome (MetS) and risk factors for metabolic derangement in young adults with childhood-onset hypopituitary growth hormone deficiency (ACOHGHD). Methods: Thirty patients with ACOHGHD who were treated with hormone-replacement therapy, aged 18 to 29 years, who visited the Seoul National University Children's Hospital between September 2009 and February 2010 were enrolled. Height, weight, waist circumference, hip circumference, and blood pressure were measured, and the clinical and hormonal features were reviewed retrospectively. We evaluated measures of metabolic derangement in the enrolled patients and in the data of healthy adults aged 20 to 29 years taken from the 2005 Korean National Health and Nutrition Examination Survey (KNHANES) as part of the National Cholesterol Education Program-the Adult Treatment Panel III. Results: Compared with the KNHANES participants, patients with ACOHGHD had significantly large waist circumference (men and women), high systolic blood pressure (BP) (women) and diastolic BP (men), and high serum triglyceride levels (women). The duration of illness correlated significantly with central obesity ($r^2$=0.546, $P$=0.003). The prevalence of MetS was 10% in patients with ACOHGHD and 2.3% in KNHANES participants. The prevalence of central obesity and MetS was higher in patients with ACOHGHD than in KNHANES participants ($P$<0.001 and $P$=0.042, respectively). Conclusion: Abdominal obesity correlated with the duration of illness in patients with ACOHGHD. Waist circumference should be measured in the clinic to prevent MetS, particularly in patients with a long history of ACOHGHD, regardless of age or sex.

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References

  1. Bulow B, Hagmar L, Mikoczy Z, Nordstrom CH, Erfurth EM. Increased cerebrovascular mortality in patients with hypopituitarism. Clin Endocrinol (Oxf) 1997;46:75-81. https://doi.org/10.1046/j.1365-2265.1997.d01-1749.x
  2. Verhelst J, Abs R. Long-term growth hormone replacement therapy in hypopituitary adults. Drugs 2002;62:2399-412. https://doi.org/10.2165/00003495-200262160-00006
  3. Erfurth EM, Hagmar L. Cerebrovascular disease in patients with pituitary tumors. Trends Endocrinol Metab 2005;16:334-42. https://doi.org/10.1016/j.tem.2005.07.004
  4. Hoybye C, Jonsson P, Monson JP, Kołtowska-Haggstrom M, Hana V, Geffner M, et al. Impact of the primary aetiology upon the clinical outcome of adults with childhood-onset GH deficiency. Eur J Endocrinol 2007;157:589-96. https://doi.org/10.1530/EJE-07-0364
  5. Fukuda I, Hizuka N, Yasumoto K, Morita J, Kurimoto M, Takano K. Metabolic co-morbidities revealed in patients with childhood-onset adult GH deficiency after cessation of GH replacement therapy for short stature. Endocr J 2008;55:977-84. https://doi.org/10.1507/endocrj.K08E-079
  6. Molitch ME, Clemmons DR, Malozowski S, Merriam GR, Shalet SM, Vance ML, et al. Evaluation and treatment of adult growth hormone deficiency: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2006;91:1621-34. https://doi.org/10.1210/jc.2005-2227
  7. Cornier MA, Dabelea D, Hernandez TL, Lindstrom RC, Steig AJ, Stob NR, et al. The metabolic syndrome. Endocr Rev 2008;29:777-822. https://doi.org/10.1210/er.2008-0024
  8. Alberti KG, Zimmet P, Shaw J; IDF Epidemiology Task Force Consensus Group. The metabolic syndrome-a new worldwide definition. Lancet 2005;366:1059-62. https://doi.org/10.1016/S0140-6736(05)67402-8
  9. Holmer H, Svensson J, Rylander L, Johannsson G, Rosén T, Bengtsson BA, et al. Nonfatal stroke, cardiac disease, and diabetes mellitus in hypopituitary patients on hormone replacement including growth hormone. J Clin Endocrinol Metab 2007;92:3560-7. https://doi.org/10.1210/jc.2007-0458
  10. Johannsson G, Bengtsson BA. Growth hormone and the metabolic syndrome. J Endocrinol Invest 1999;22:41-6.
  11. Ford ES. Risks for all-cause mortality, cardiovascular disease, and diabetes associated with the metabolic syndrome: a summary of the evidence. Diabetes Care 2005;28:1769-78. https://doi.org/10.2337/diacare.28.7.1769
  12. Attanasio AF, Mo D, Erfurth EM, Tan M, Ho KY, Kleinberg D, et al. Prevalence of metabolic syndrome in adult hypopituitary growth hormone (GH)-deficient patients before and after GH replacement. J Clin Endocrinol Metab 2010;95:74-81. https://doi.org/10.1210/jc.2009-1326
  13. WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004;363:157-63. https://doi.org/10.1016/S0140-6736(03)15268-3
  14. Gallagher D. Overweight and obesity BMI cut-offs and their relationship to metabolic disorders in Koreans/Asians. Obes Res 2004;12:440-1. https://doi.org/10.1038/oby.2004.48
  15. Park YW, Zhu S, Palaniappan L, Heshka S, Carnethon MR, Heymsfield SB. The metabolic syndrome: prevalence and associated risk factor findings in the US population from the Third National Health and Nutrition Examination Survey, 1988-1994. Arch Intern Med 2003;163:427-36. https://doi.org/10.1001/archinte.163.4.427
  16. Flegal KM, Carroll MD, Kuczmarski RJ, Johnson CL. Overweight and obesity in the United States: prevalence and trends,1960-1994. Int J Obes Relat Metab Disord 1998;22:39-47. https://doi.org/10.1038/sj.ijo.0800541
  17. Mokdad AH, Bowman BA, Ford ES, Vinicor F, Marks JS, Koplan JP. The continuing epidemics of obesity and diabetes in the United States. JAMA 2001;286:1195-200. https://doi.org/10.1001/jama.286.10.1195
  18. Chen H, Sullivan G, Yue LQ, Katz A, Quon MJ. QUICKI is a useful index of insulin sensitivity in subjects with hypertension. Am J Physiol Endocrinol Metab 2003;284:E804-12. https://doi.org/10.1152/ajpendo.00330.2002
  19. Maison P, Griffin S, Nicoue-Beglah M, Haddad N, Balkau B, Chanson P. Impact of growth hormone (GH) treatment on cardiovascular risk factors in GH-deficient adults: a meta-analysis of blinded, randomized, placebocontrolled trials. J Clin Endocrinol Metab 2004;89:2192-9. https://doi.org/10.1210/jc.2003-030840
  20. van der Klaauw AA, Biermasz NR, Feskens EJ, Bos MB, Smit JW, Roelfsema F, et al. The prevalence of the metabolic syndrome is increased in patients with GH deficiency, irrespective of long term substitution with recombinant human GH. Eur J Endocrinol 2007;156:455-62. https://doi.org/10.1530/EJE-06-0699
  21. Balkau B, Vernay M, Mhamdi L, Novak M, Arondel D, Vol S, et al. The incidence and persistence of the NCEP (National Cholesterol Education Program) metabolic syndrome. The French D.E.S.I.R. study. Diabetes Metab 2003;29:526-32. https://doi.org/10.1016/S1262-3636(07)70067-8
  22. Carroll PV, Christ ER, Bengtsson BA, Carlsson L, Christiansen JS, Clemmons D, et al.. Growth hormone deficiency in adulthood and the effects of growth hormone replacement: a review. J Clin Endocrinol Metab 1998;83:382-95. https://doi.org/10.1210/jc.83.2.382
  23. Park J, Mendoza JA, O'Neil CE, Hilmers DC, Liu Y, Nicklas TA. A comparison of the prevalence of the metabolic syndrome in the United States (US) and Korea in young adults aged 20 to 39 years. Asia Pac J Clin Nutr 2008;17:471-82.
  24. Sesmilo G, Miller K, Hayden D, Klibanski A. Inflammatory cardiovascular risk markers in women with hypopituitarism. J Clin Endocrinol Metab 2001;86:5774-81. https://doi.org/10.1210/jc.86.12.5774
  25. Bulow B, Hagmar L, Eskilsson J, Erfurth EM. Hypopituitary females have a high incidence of cardiovascular morbidity and an increased prevalence of cardiovascular risk factors. J Clin Endocrinol Metab 2000;85:574-84. https://doi.org/10.1210/jc.85.2.574
  26. Attanasio AF. Childhood onset adult growth hormone deficiency and hypopituitarism: a black box. In: Webb S, Chanson P, editors. A decade of HypoCCS: the changing face of pituitary disease. Bristol, UK: Bioscentifica Ltd, 2008:61-71.
  27. Attanasio AF, Lamberts SW, Matranga AM, Birkett MA, Bates PC, Valk NK, et al. Adult growth hormone (GH)-deficient patients demonstrate heterogeneity between childhood onset and adult onset before and during human GH treatment. J Clin Endocrinol Metab 1997;82:82-8. https://doi.org/10.1210/jc.82.1.82
  28. Besson A, Salemi S, Gallati S, Jenal A, Horn R, Mullis PS, et al. Reduced longevity in untreated patients with isolated growth hormone deficiency. J Clin Endocrinol Metab 2003;88:3664-7. https://doi.org/10.1210/jc.2002-021938

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