Growth hormone deficiency and cardiovascular risk

It is now recognized that growth hormone (GH) deficiency in adults represen ts a distinct clinical syndrome that encompasses reduced psychological well -being as well as specific metabolic abnormalities. The latter features, wh ich include hypertension, central obesity, insulin resistance, dyslipidaemi a and coagulopathy, closely resemble those of metabolic insulin resistance syndrome. The increased cardiovascular morbidity and mortality demonstrated in these GH-deficient (GHD) adults reinforce the close association between the two syndromes. Replacement of GH in GHD adults has resulted in a marked reduction of centr al obesity and significant reduction in total cholesterol but little change in other-risk factors, in particular insulin resistance and dyslipidaemia. The persistent insulin resistance and dyslipidaemia, together with the ele vation of plasma insulin levels and lipoprotein (a) with GH replacement in these subjects are of concern. Long-term follow-up data are required to ass ess the impact of GH replacement on the cardiovascular morbidity and mortal ity of GHD adults. Further exploration of the appropriateness of the GH dos age regimens currently being employed is also indicated.