Influence of gender and gonadal steroids on responsiveness to growth hormone replacement therapy in adults with growth hormone deficiency

Abstract

In children with growth hormone deficiency (GHD), the importance of puberty and gonadal steroids on the growth plate during growth hormone (GH)treatment has long been known. However, our understanding of the impact and possible modulatory effects of gonadal steroids on various aspects of GHD and GH treatment in adults is limited. Well-controlled clinical studies have shown that GHD in adults is associated with an increase in cardiovascular risk factors. 1 Thus, adults with GHD have an increased amount of body fat, predominantly in the abdomen, 2,3 an increased prevalence of (treated) hypertension, 4 impaired fibrinolysis, 2 glucose intolerance, 5 insulin resistance 6 and premature atherosclerosis. 7 This cluster of cardiovascular risk factors associated with GHD may help to explain the doubling in cardiovascular mortality observed in these patients. 8,9 In addition, quality of life is impaired 1°,~ and bone mass and density are reduced. ~2-14 The effect of gender and gonadal steroids on these aberrations has been investigated in only a few studies. The purpose of this review is to summarize the data that are available on the possible modulatory action of gonadal steroids/gender on the effects of GH replacement therapy in adults with GHD.