Abstract
Non-alcoholic fatty liver disease (NAFLD) is common in patients with growth hormone deficiency (GHD). Some noninvasive techniques have been used to quantify liver fat, such as the controlled attenuation parameter (CAP).Objective: To evaluate CAP as a tool to identify liver steatosis and its relationship with different clinical and biochemical metabolic parameters in a group of patients with severe adult growth hormone deficiency (AGHD), and to compare the evolution of metabolic profiles after 6 months of human growth hormone (rhGH) replacement therapy in a subgroup of patients.Methods: Cross-sectional observational study at baseline of naive rhGH multiple pituitary hormonal deficiency (MPHD) hypopituitarism patients. A 6-month intervention clinical trial in a selected group of a non-randomized, non-controlled cohort was also applied.Results: Liver stiffness measurement (LSM) was normal in severe AGHD patients. CAP evaluation showed steatosis in 36.3% of baseline patients (8/22), associated with higher BMI, waist circumference, insulin, and alanine aminotransferase (ALT) levels. According to steatosis degree by CAP, child-onset growth hormone deficiency (CO-GHD) was graded as 68.75% (11/16) S0, 12.5% (2/16) S1, and 18.75% (3/16) S3, whereas AO-GHD was graded as 50% (3/6) S0, 16.66% (1/6) S2, and 33.33% S3. After 6 months of hrGH replacement, CAP measurements did not change significantly, neither on group without hepatic steatosis at baseline (194.4 ± 24.3 vs. 215.4 ± 51.3; p = 0.267) nor on the group with hepatic steatosis (297.2 ± 32.3 vs. 276.4 ± 27.8; p = 0.082). A significant improvement of body composition was observed only in the first group.Conclusions: We have demonstrated the importance of CAP as a non-invasive tool in the liver steatosis identification on hypopituitary patients. This method may be an important indicator of the severity of metabolic disorders in MPHD patients. In our study, no liver health modification in LSM at baseline or after 6 months of rhGH replacement was found. Longer studies can help to establish the potential repercussions of growth hormone replacement therapy on liver steatosis.
Highlights
Significant metabolic changes are observed in AGHD, such as negative effects on lipoprotein metabolism, lean mass reduction, fat mass increase, and intra-abdominal fat, leading to an increased risk of cardiovascular events [1,2,3]
The aim of this study is to evaluate the relationship of controlled attenuation parameter (CAP) with different clinical and biochemical metabolic parameters in a group of patients with severe AGHD
In addition to accurately evaluating liver stiffness measurement (LSM), Transient elastography (TE) is capable of quantifying hepatic steatosis through a physical parameter (CAP), which is simultaneously acquired with LSM by the FibroScan probe and which estimates the liver attenuation levels [17, 18]
Summary
Significant metabolic changes are observed in AGHD, such as negative effects on lipoprotein metabolism, lean mass reduction, fat mass increase, and intra-abdominal fat, leading to an increased risk of cardiovascular events [1,2,3]. Central obesity and altered lipid profiles give rise to the development of Metabolic Syndrome (MetS), which has insulin resistance as a key pathogenic mechanism [4]. NAFLD is used to define the accumulation of liver fat in a patient without a prior history of alcohol abuse. The higher concentration of lipids, especially triglycerides in hepatocytes, leads to the development of hepatic steatosis, defined as the accumulation of fatty tissue higher than 5% of liver weight [5, 6]. Hepatic steatosis is considered a reversible change but may progress to an inflammatory process (steatohepatitis) and to liver cirrhosis. In this case, it may lead to a higher risk of hepatocarcinoma [7, 8]. NAFLD represents an isolated cardiovascular risk factor and is associated with an increased incidence of cardiovascular disease [9]
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