What Happens When Long Term Growth Hormone is Stopped

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Study Looked at What Happens When Long Term Growth Hormone Replacement Therapy is Stopped

Discontinuing Long-Term GH Replacement Therapy—A Randomized, Placebo-Controlled Crossover Trial in Adult GH Deficiency


Department of Endocrinology, Sahlgrenska University Hospital, and Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, SE-41345 Göteborg, Sweden

Abstract

Context: Adult GH deficiency (GHD) is associated with impaired quality of life (QoL) and increased cardiovascular risk. Continued long-term efficacy in terms of QoL and cardiovascular risk factors has been indicated in open surveillance studies.

Objectives: The aim was to study the impact of discontinuation of long-term GH replacement on QoL, body composition, and metabolism.

Design and Setting: We conducted a randomized, double-blind, placebo-controlled 4-month crossover trial in a referral center.

Patients: Sixty adult hypopituitary patients with GHD and more than 3 yr of continuous GH replacement therapy (mean treatment duration, 10 yr) participated in the study.

Intervention: Patients received GH or placebo.

Main Outcome Measurements: We measured QoL using validated questionnaires; body composition using computer tomography, dual-energy x-ray absorptiometry, and bioelectrical impedance spectroscopy; and insulin sensitivity using the short insulin tolerance test.

Results: Mean serum IGF-I decreased from 168± 52 to 98± 47 µg/liter during the placebo period (P< 0.001). Two QoL domains (emotional reactions and positive well-being) in the Nottingham Health Profile and Psychological General Well-Being questionnaires deteriorated during placebo, compared with GH treatment (P< 0.05). Waist circumference and sc and visceral fat mass increased, and extracellular water and muscle area decreased during the placebo period (all P< 0.05). C-reactive protein and total-, low-density lipoprotein-, and high-density lipoprotein-cholesterol increased, and insulin sensitivity improved during placebo, compared to GH treatment (P< 0.05).

Conclusion: After more than 3 yr of GH replacement therapy, a 4-month period of placebo treatment caused self-perceived deterioration in QoL and increased abdominal fat accumulation. Moreover, markers of systemic inflammation and lipid status deteriorated, whereas insulin sensitivity improved. Long-term continuous GH replacement is needed to maintain therapeutic effects of GH on QoL and cardiovascular risk factors.

 

[Jasen Bruce]

Since this study was using patients with true adult GH deficiency it seems common sense that QoL and blood levels will decrease once Dx. I am curious to see some data on the multitude of patients who were not truly growth hormone deficient who were on HGH through "anti-aging" clinics prescribing it for both cosmetic and subjective "sub-optimal" reasons.

The patients I have the opportunity to work with, who had been on HGH for many years and can no longer obtain it due to tougher prescribing regs, appear to have sustained low levels many months after discontinuing. For some, Sermorelin has restored them sufficiently but it takes a long time (and patience from the patient). Starting the patient with 2mg QHS for 6 months then dropping to 1mg, going from there, seems to have worked well although this is only an observation on a handful of patients between the pharmacy and clinics I have worked for over the years. If the pituitary functions, recovery should be possible but previous long term GH users should understand that it will take time even with aggressive stimulation.

Those who truly have a pituitary disorder which causes adult growth hormone deficiency will require replacement with rHGH since stimulatory hormones such as Sermorelin will not work.

 

[Tom Larabee]

What is the test to determine if the pituitary is actually not providing the appropriate GH? I was in a head trauma accident back in 77 and was wondering if there is a way to determine, similar to how it was done to determine secondary hypo-gonadism

 

[Neil Olson]

I can speak on decreased QoL from the stand point of someone with a pituitary disorder. I started back in 1975 at the age of 5 and quit when I was 17 due to no longer being able to grow. I started on the cadaver derived GH then was put through the trials of the synthetic brand. I was lucky I got to take synthetic before it was even approved by the FDA.

As a young boy I had a pretty good life other than being shorter than my peers. I was on the baseball team, track team, and a wrestler. We also live on a ranch and could hang with my brothers during our chores.

Doctors took me off in 1987. My QoL started to decline fairly quickly. I was able to put a couple years in the Navy. I started losing muscle, gaining weight, and my ability to exercise started to decrease. I wanted to exercise, but my body didn't. My way to compensate for all this was to start drinking heavily. It numbed my feeling like crap all the time.

I am now back on GH, but don't think I will ever be the same. I think being off it has done to much damage to my body.