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Acquired growth hormone resistance in patients with chronic heart failure: Implications for therapy with growth hormone

Item Type:Article
Title:Acquired growth hormone resistance in patients with chronic heart failure: Implications for therapy with growth hormone
Creators Name:Anker, S.D. and Volterrani, M. and Pflaum, C.D. and Strasburger, C.J. and Osterziel, K.J. and Doehner, W. and Ranke, M.B. and Poole-Wilson, P.A. and Giustina, A. and Dietz, R. and Coats, A.J.S.
Abstract:OBJECTIVES: We aimed to determine whether growth hormone (GH) resistance is present in patients with chronic heart failure (CHF) and whether it may be linked to the biochemical response to GH treatment. BACKGROUND: Acquired GH resistance is a feature of severe illness, in particular, cachexia. In patients with CHF, the response to GH therapy appears to be variable. METHODS: Biochemical markers of the GH-insulin-like growth factor-I (IGF-I) axis were compared in 21 cachectic patients with CHF, 51 noncachectic patients and 26 healthy control subjects. In separate studies, the predictive value of baseline biochemical variables for the IGF-I response to GH treatment was analyzed. RESULTS: Cachectic patients showed an increase of total GH and immunologically intact GH (p ≤ 0.0002) and a decrease of GH-binding protein (BP) (p = 0.005), IGF-BP3 (p = 0.01) and IGF-I (p = 0.06), compared with noncachectic patients. Similar changes were found when the cachectic group was compared with the control group. No differences were found between noncachectic patients and control subjects. Levels of GH-BP correlated with the IGF-I/GH ratio in all subgroups (all p ≤ 0.002). Baseline GH-BP levels were related to the increase of IGF-I levels in response to GH treatment in patients with CHF after 24 h (r = 0.83, p = 0.005; n = 9; study 2), 44 days (r = 0.52, p = 0.007; n = 25; study 3) and 96 days (r = 0.54, p = 0.006; n = 24; study 3). CONCLUSIONS: Most cachectic and some noncachectic patients with CHF show features of acquired GH resistance. The principal predictors of the biochemical features of GH resistance and of the poor biochemical response to short-term and longer-term GH treatment are GH-BP plasma levels. The presence of GH resistance is potentially a major factor determining the response to GH therapy in patients with CHF.
Keywords:Biological Markers, Body Composition, Cachexia, Carrier Proteins, Chronic Disease, Congestive Heart Failure, Drug Tolerance, Fasting, Human Growth Hormone, Insulin-Like Growth Factor I, Prospective Studies, Time Factors
Source:Journal of the American College of Cardiology
Page Range:443-452
Date:1 January 2001
Official Publication:https://doi.org/10.1016/S0735-1097(01)01385-7
PubMed:View item in PubMed

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