Pediatric clinicians often focus on the “growth” aspects of growth hormone deficiency, but there are other reasons to care about the condition beyond linear growth. In a new paper, Rohan Henry, MD, MS, an endocrinologist at Nationwide Children’s Hospital, makes the case for the metabolic benefits of growth hormone.
In addition to its growth-promoting role, growth hormone has a significant two-phase effect on glucose metabolism. In the initial phase, growth hormone has an insulin-like effect that causes a decrease in glucose. The second phase involves gluconeogenesis and fat mobilization.
These metabolic aspects of growth hormone remain important even after the period of linear growth. In cases of growth hormone deficiency, metabolic abnormalities may develop, including nonalcoholic fatty liver disease, the hepatic manifestation of insulin resistance.
“Fatty liver disease is a condition in which the liver has undergone some injury and because of that there is an accumulation of triglycerides and cholesterol,” says Dr. Henry. “Growth hormone is one piece of the puzzle that can affect the development of fatty liver disease.”
Dr. Henry says a couple of his patients inspired him to look further into the connection between growth hormone deficiency and fatty liver disease. His review of the literature revealed various animal and human studies (mostly in adults) and clinical reports in children showing the association of growth hormone deficiency and metabolism. For instance, when men with hypopituitarism and glucose dysregulation received growth hormone therapy, the glucose dysregulation went away.
Dr. Henry says that growth hormone supplementation in individuals with severe growth hormone deficiency after the completion of linear growth is also associated with improvement in lipid profile and quality of life measures.
Based on the association between growth hormone and metabolism, Dr. Henry encourages pediatric clinicians to ensure that patients with severe growth hormone deficiency are appropriately treated even beyond the period of linear growth.
“Pediatric practitioners should stress to patients to be compliant and adhere to the growth hormone regimen and follow up with their endocrinologist because even after growth is completed, growth hormone is important for metabolic aspects,” says Dr. Henry.
Now, Dr. Henry hopes to draw people’s attention to the metabolic benefits of growth hormone.
“When I had these patients, I sought input from many individuals both inside the institution and externally but, people were not aware of this, even though it is out there in the literature,” says Dr. Henry. “Once clinicians realize this, they will be able to look for it more.”
“As pediatric practitioners, we might not see these metabolic complications emerge until later in adulthood, but we can set these patients up for a healthy life in the future.”
Reference:Henry, RK. Growth hormone deficiency and nonalcoholic fatty liver disease with insights from humans and animals: pediatric implications. Metabolic Syndrome and Related Disorders. 2018 Oct 20. [Epub ahead of print]