Growth hormone treatment of children with Prader-Willi syndrome: Effects on glucose and insulin homeostasis

Insulin and glucose homeostasis have been studied during growth hormone (GH ) treatment in 19 prepubertal children with Prader-Willi syndrome (PWS) and compared with 11 healthy prepubertal obese children. Before treatment, ins ulin levels in children with PWS were lower (p < 0.01) than in healthy obes e children. During GH treatment, fasting insulin levels increased in childr en with PWS (p < 0.001), Glucose levels were similar for PWS and obese chil dren before treatment. Children with PWS showed a slow glucose disappearanc e rate (k = 1.7%) wh ich deteriorated (k = 1.3%, p < 0.001) during GH treat ment. HbA1c and fasting glucose levels remained normal. Thus, GH treatment of children with PWS resulted in increased insulin blood levels, unchanged fasting glucose and HbA1c but decreased glucose elimination rate after an i ntravenous glucose test. However, the observed dose-dependent increase in i nsulin levels during GH treatment, that reached supranormal concentrations in 6/19 patients, and the occurrence of NIDDM in 1 patient during follow-up suggest that close surveillance and low doses of GH should be applied, esp ecially if the PWS patient is very obese.