Abstract

BackgroundThe aim of the present study was to investigate the effect of low-normal and high-normal levels of IGF-1 in growth hormone (GH) deficient adults on cognition and wellbeing during GH treatment.MethodsA randomized, open-label, clinical trial including 32 subjects receiving GH therapy for at least 1 year. Subjects were randomized to receive either a decrease (IGF-1 target level of − 2 to − 1 SDS) or an increase of their daily GH dose (IGF-1 target level of 1 to 2 SDS) for a period of 24 weeks. Memory was measured by the Cambridge Neuropsychological Test Automated Battery, selecting the Pattern Recognition Memory task and the Spatial Working Memory. Wellbeing was measured as mood by the Profile of Moods States questionnaire, and quality of life by the Nottingham Health Profile and QoL Assessment in GH Deficiency in Adults questionnaires.ResultsData from 30 subjects (65.6% male, mean age 46.6 (9.9 SD) years), who fulfilled the target levels, were analyzed. Females in the low dose treatment arm were found to have a better working memory and a better strategic memory control after 24 weeks as opposed to the females in the high treatment arm. With respect to mood, the decrease in IGF-1 levels in females within the low treatment arm was associated with more fatigue and less vigor.ConclusionsThe adjustment of GH dose in female patients seems to have a narrow window. A dose too high may impair prefrontal cognitive functioning, while a dose too low may result in decreased vigor.Trial registrationThis study is registered with ClinicalTrials.gov, number NCT01877512.

Highlights

  • The aim of the present study was to investigate the effect of low-normal and high-normal levels of insulin-like growth factor-1 (IGF-1) in growth hormone (GH) deficient adults on cognition and wellbeing during GH treatment

  • Growth hormone (GH) deficiency in adults may lead to a broad range of detrimental physical and/or psychological effects [1], while there is evidence that GH treatment has a positive effect on body composition, lipid profile, hypertension, bone density, and quality of life

  • Study design This study presents outcome data on cognition and wellbeing from a randomized, open-label, clinical trial conducted at one university hospital (VU University Medical Center, Amsterdam, The Netherlands) which compared de- and increasing GH dose for 24 weeks with low-normal and high-normal IGF-1 target levels for efficacy and safety measures of GH replacement therapy [37]

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Summary

Introduction

The aim of the present study was to investigate the effect of low-normal and high-normal levels of IGF-1 in growth hormone (GH) deficient adults on cognition and wellbeing during GH treatment. Growth hormone (GH) deficiency in adults may lead to a broad range of detrimental physical and/or psychological effects [1], while there is evidence that GH treatment has a positive effect on body composition, lipid profile, hypertension, bone density, and quality of life (QoL) [2,3,4,5]. GH deficiency is accompanied with subnormal IQ scores, memory impairment, and a low educational level. These manifestations are associated with a low insulin-like growth factor-1 (IGF-1) concentration, suggesting that subnormal cognitive performance is related to GH deficiency [10]. Van Bunderen et al Health and Quality of Life Outcomes (2018) 16:135

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