Multiple hormone deficiencies in chronic heart failure

Abstract

Anabolic hormones are endowed with powerful actions on both the cardiovascular system and the skeletal muscle. In western countries, an age-related decline of anabolic hormones including IGF-1, testosterone and DHEA-S is extensively described, and thought to contribute to sarcopenia, visceral adiposity and osteopenia. This decline has been often referred to as somato- and andro-pause [ 4 Cittadini A. Marra A.M. Arcopinto M. et al. Growth hormone replacement delays the progression of chronic heart failure combined with growth hormone deficiency: an extension of a randomized controlled single-blind study. JACC Heart Fail. 2013; 1: 325-330 Crossref PubMed Scopus (58) Google Scholar , 5 Arcopinto M. Isgaard J. Marra A.M. et al. IGF-1 predicts survival in chronic heart failure. Insights from the T.O.S.CA. (Trattamento Ormonale Nello Scompenso CArdiaco) registry. Int. J. Cardiol. 2014; 176: 1006-1008 Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar ]. In the last decade, a growing body of evidence has led to the hypothesis that chronic heart failure (CHF) is indeed a multiple hormone deficiency syndrome (MHDS), characterized by a reduced anabolic drive that bears relevant functional and prognostic implications [ 1 Sacca L. Heart failure as a multiple hormonal deficiency syndrome. Circ. Heart Fail. 2009; 2: 151-156 Crossref PubMed Scopus (72) Google Scholar , 2 Jankowska E.A. Biel B. Majda J. et al. Anabolic deficiency in men with chronic heart failure: prevalence and detrimental impact on survival. Circulation. 2006; 114: 1829-1837 Crossref PubMed Scopus (320) Google Scholar ]. Of note, Growth Hormone (GH) or testosterone replacement therapy provides beneficial effects, particularly on exercise tolerance and well-being [ [3] Nguyen C.T. Aaronson A. Morrissey R.P. Agarwal M. Willix R.D. Schwarz E.R. Myths and truths of growth hormone and testosterone therapy in heart failure. Expert. Rev. Cardiovasc. Ther. 2011; 9: 711-720 Crossref PubMed Scopus (10) Google Scholar ].