Skip to main content
Archives of Disease in Childhood logoLink to Archives of Disease in Childhood
. 1999 Jun;80(6):517–523. doi: 10.1136/adc.80.6.517

Metabolic effects of discontinuing growth hormone treatment

F Cowan 1, W Evans 1, J Gregory 1
PMCID: PMC1717958  PMID: 10331999

Abstract

AIMS—To evaluate the effects of discontinuing growth hormone (GH) treatment on energy expenditure and body composition, which might help predict those most likely to benefit from early reintroduction of GH treatment in young adult life.
METHODS—Body composition was calculated from skinfold thicknesses and dual energy x ray absorptometry (DXA). Resting metabolic rate (RMR) and whole body bone mineral content (BMC) were also measured. Measurements were made before stopping treatment, at discontinuation of GH treatment, and two weeks, six months, and one year later in 11 adolescents with growth hormone deficiency (GHD) and five adolescents without GHD who were treated with GH. Measurements were compared with 10 healthy controls, in whom measurements were repeated one year later.
RESULTS—During the nine months before discontinuation of GH there were no changes in body composition, RMR, or BMC of patients with GHD, nor differences when compared with controls. RMR was reduced by 11.3 kJ/kg fat free mass two weeks after stopping GH in GHD patients and remained suppressed thereafter compared with controls. Percentage body fat increased by 4.3%/year in patients with GHD after discontinuing GH, whereas no changes were noted in control or non-GHD patients at one year. The patients experiencing the greatest reductions in RMR/kg fat free mass at six months showed the largest increases in body fat at one year. No change in BMC was noted in patients one year after stopping treatment.
CONCLUSION—Important metabolic changes occur early after discontinuing GH treatment. In patients whose growth is complete, these changes might be used to predict those most likely to benefit from continuation of GH treatment into adult life.



Full Text

The Full Text of this article is available as a PDF (125.8 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Beshyah S. A., Freemantle C., Shahi M., Anyaoku V., Merson S., Lynch S., Skinner E., Sharp P., Foale R., Johnston D. G. Replacement treatment with biosynthetic human growth hormone in growth hormone-deficient hypopituitary adults. Clin Endocrinol (Oxf) 1995 Jan;42(1):73–84. doi: 10.1111/j.1365-2265.1995.tb02601.x. [DOI] [PubMed] [Google Scholar]
  2. Beshyah S. A., Freemantle C., Thomas E., Rutherford O., Page B., Murphy M., Johnston D. G. Abnormal body composition and reduced bone mass in growth hormone deficient hypopituitary adults. Clin Endocrinol (Oxf) 1995 Feb;42(2):179–189. doi: 10.1111/j.1365-2265.1995.tb01860.x. [DOI] [PubMed] [Google Scholar]
  3. Bland J. M., Altman D. G. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986 Feb 8;1(8476):307–310. [PubMed] [Google Scholar]
  4. Cole T. J., Freeman J. V., Preece M. A. Body mass index reference curves for the UK, 1990. Arch Dis Child. 1995 Jul;73(1):25–29. doi: 10.1136/adc.73.1.25. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Colle M., Auzerie J. Discontinuation of growth hormone therapy in growth-hormone-deficient patients: assessment of body fat mass using bioelectrical impedance. Horm Res. 1993;39(5-6):192–196. doi: 10.1159/000182734. [DOI] [PubMed] [Google Scholar]
  6. Cuneo R. C., Salomon F., McGauley G. A., Sönksen P. H. The growth hormone deficiency syndrome in adults. Clin Endocrinol (Oxf) 1992 Nov;37(5):387–397. doi: 10.1111/j.1365-2265.1992.tb02347.x. [DOI] [PubMed] [Google Scholar]
  7. Durnin J. V., Rahaman M. M. The assessment of the amount of fat in the human body from measurements of skinfold thickness. Br J Nutr. 1967 Aug;21(3):681–689. doi: 10.1079/bjn19670070. [DOI] [PubMed] [Google Scholar]
  8. Freeman J. V., Cole T. J., Chinn S., Jones P. R., White E. M., Preece M. A. Cross sectional stature and weight reference curves for the UK, 1990. Arch Dis Child. 1995 Jul;73(1):17–24. doi: 10.1136/adc.73.1.17. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Gregory J. W., Greene S. A., Jung R. T., Scrimgeour C. M., Rennie M. J. Changes in body composition and energy expenditure after six weeks' growth hormone treatment. Arch Dis Child. 1991 May;66(5):598–602. doi: 10.1136/adc.66.5.598. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Gregory J. W., Greene S. A., Jung R. T., Scrimgeour C. M., Rennie M. J. Metabolic effects of growth hormone treatment: an early predictor of growth response? Arch Dis Child. 1993 Feb;68(2):205–209. doi: 10.1136/adc.68.2.205. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Hansen T. B., Vahl N., Jørgensen J. O., Christiansen J. S., Hagen C. Whole body and regional soft tissue changes in growth hormone deficient adults after one year of growth hormone treatment: a double-blind, randomized, placebo-controlled study. Clin Endocrinol (Oxf) 1995 Dec;43(6):689–696. doi: 10.1111/j.1365-2265.1995.tb00536.x. [DOI] [PubMed] [Google Scholar]
  12. Juul A., Jørgensen J. O., Christiansen J. S., Müller J., Skakkeboek N. E. Metabolic effects of GH: a rationale for continued GH treatment of GH-deficient adults after cessation of linear growth. Horm Res. 1995;44 (Suppl 3):64–72. doi: 10.1159/000184676. [DOI] [PubMed] [Google Scholar]
  13. Jørgensen J. O., Pedersen S. A., Thuesen L., Jørgensen J., Ingemann-Hansen T., Skakkebaek N. E., Christiansen J. S. Beneficial effects of growth hormone treatment in GH-deficient adults. Lancet. 1989 Jun 3;1(8649):1221–1225. doi: 10.1016/s0140-6736(89)92328-3. [DOI] [PubMed] [Google Scholar]
  14. Lönn L., Johansson G., Sjöström L., Kvist H., Odén A., Bengtsson B. A. Body composition and tissue distributions in growth hormone deficient adults before and after growth hormone treatment. Obes Res. 1996 Jan;4(1):45–54. doi: 10.1002/j.1550-8528.1996.tb00511.x. [DOI] [PubMed] [Google Scholar]
  15. McGauley G., Cuneo R., Salomon F., Sönksen P. H. Growth hormone deficiency and quality of life. Horm Res. 1996;45(1-2):34–37. doi: 10.1159/000184756. [DOI] [PubMed] [Google Scholar]
  16. Nicolson A., Toogood A. A., Rahim A., Shalet S. M. The prevalence of severe growth hormone deficiency in adults who received growth hormone replacement in childhood [see comment]. Clin Endocrinol (Oxf) 1996 Mar;44(3):311–316. doi: 10.1046/j.1365-2265.1996.671492.x. [DOI] [PubMed] [Google Scholar]
  17. Ogle G. D., Moore B., Lu P. W., Craighead A., Briody J. N., Cowell C. T. Changes in body composition and bone density after discontinuation of growth hormone therapy in adolescence: an interim report. Acta Paediatr Suppl. 1994 Apr;399:3–8. doi: 10.1111/j.1651-2227.1994.tb13274.x. [DOI] [PubMed] [Google Scholar]
  18. Rosén T., Bosaeus I., Tölli J., Lindstedt G., Bengtsson B. A. Increased body fat mass and decreased extracellular fluid volume in adults with growth hormone deficiency. Clin Endocrinol (Oxf) 1993 Jan;38(1):63–71. doi: 10.1111/j.1365-2265.1993.tb00974.x. [DOI] [PubMed] [Google Scholar]
  19. Rosén T., Johannsson G., Johansson J. O., Bengtsson B. A. Consequences of growth hormone deficiency in adults and the benefits and risks of recombinant human growth hormone treatment. A review paper. Horm Res. 1995;43(1-3):93–99. doi: 10.1159/000184245. [DOI] [PubMed] [Google Scholar]
  20. Rutherford O. M., Jones D. A., Round J. M., Preece M. A. Changes in skeletal muscle after discontinuation of growth hormone treatment in young adults with hypopituitarism. Acta Paediatr Scand Suppl. 1989;356:61-3; discussion 64, 73-4. doi: 10.1111/j.1651-2227.1989.tb11244.x. [DOI] [PubMed] [Google Scholar]
  21. Salomon F., Cuneo R. C., Hesp R., Sönksen P. H. The effects of treatment with recombinant human growth hormone on body composition and metabolism in adults with growth hormone deficiency. N Engl J Med. 1989 Dec 28;321(26):1797–1803. doi: 10.1056/NEJM198912283212605. [DOI] [PubMed] [Google Scholar]
  22. Svendsen O. L., Haarbo J., Hassager C., Christiansen C. Accuracy of measurements of body composition by dual-energy x-ray absorptiometry in vivo. Am J Clin Nutr. 1993 May;57(5):605–608. doi: 10.1093/ajcn/57.5.605. [DOI] [PubMed] [Google Scholar]
  23. Warner J. T., Cowan F. J., Dunstan F. D., Evans W. D., Webb D. K., Gregory J. W. Measured and predicted bone mineral content in healthy boys and girls aged 6-18 years: adjustment for body size and puberty. Acta Paediatr. 1998 Mar;87(3):244–249. doi: 10.1080/08035259850157264. [DOI] [PubMed] [Google Scholar]
  24. Whitehead H. M., Boreham C., McIlrath E. M., Sheridan B., Kennedy L., Atkinson A. B., Hadden D. R. Growth hormone treatment of adults with growth hormone deficiency: results of a 13-month placebo controlled cross-over study. Clin Endocrinol (Oxf) 1992 Jan;36(1):45–52. doi: 10.1111/j.1365-2265.1992.tb02901.x. [DOI] [PubMed] [Google Scholar]
  25. de Boer H., Blok G. J., Voerman H. J., Phillips M., Schouten J. A. Serum lipid levels in growth hormone-deficient men. Metabolism. 1994 Feb;43(2):199–203. doi: 10.1016/0026-0495(94)90245-3. [DOI] [PubMed] [Google Scholar]
  26. de Boer H., van der Veen E. A. Why retest young adults with childhood-onset growth hormone deficiency? J Clin Endocrinol Metab. 1997 Jul;82(7):2032–2036. doi: 10.1210/jcem.82.7.4101. [DOI] [PubMed] [Google Scholar]

Articles from Archives of Disease in Childhood are provided here courtesy of BMJ Publishing Group

RESOURCES