Discontinuation of growth hormone (GH) treatment: Metabolic effects in GH-deficient and GH-sufficient adolescent patients compared with control subjects

The need for continuing GH replacement in patients with childhood-onset GH deficiency continuing into adulthood has been recognized. The metabolic con sequences of discontinuing GH in adolescent patients with childhood-onset G H deficiency and short stature mere examined over a period of 2 yr. Forty a dolescents (aged 16-21 yr) receiving GH treatment for more than 3 yr and 16 closely matched healthy controls were studied. After a baseline visit, GH treatment was discontinued. The patients were then examined with the same p rotocol once a year for 2 yr. Twenty-one patients had severe GH deficiency (GHD) into adulthood, whereas 19 patients were regarded as having sufficien t endogenous GH secretion (GHS). After 2 yr without GH treatment, the serum insulin-like growth factor I level was lower in GHD than in both GHS and c ontrol subjects. Both before and 2 yr after GH treatment was discontinued, serum concentrations of total cholesterol(C), low density lipoprotein C, an d apolipoprotein B were higher in the GHD than in both GHS and control subj ects. Serum concentrations of high density lipoprotein C decreased in the G HD group and increased in the other 2 study groups. The amount of total bod y and abdominal fat mass throughout the study and the increment in these ma sses mere more marked in the GHD than in the GHS and control subjects when GH treatment was discontinued. The discontinuation of GH therapy in adolescents with severe GHD continuing into adulthood results over a period of 2 yr in the accumulation of import ant cardiovascular risk factors that are associated with GHD in adults.