Toogood A A, Adams J E, O'Neill P A, Shalet S M
Department of Endocrinology, Christie Hospital NHS Trust, Manchester, UK.
Clin Endocrinol (Oxf). 1996 Oct;45(4):399-405. doi: 10.1046/j.1365-2265.1996.8310842.x.
Elderly patients with hypothalamic-pituitary disease exhibit a reduction in GH secretion distinct from the decline in GH secretion related to age. GH deficiency in young adults causes a change in body composition, with increased fat mass (FM) and reduced fat free mass (FFM), similar to that seen as a result of the normal ageing process. The aim of this study was to determine whether organic GH deficiency in elderly patients may cause changes in body composition beyond those due to ageing.
Twenty-one patients (15 male) with documented pituitary disease and 24 controls (17 male) matched for age, height, weight and BMI, all over the age of 60, in whom GH status had been defined by a 24-hour GH profile and an arginine stimulation test.
Serum was taken for fasting IGF-l and IGFBP-1 estimations. Total and regional FM and FFM were determined using dual-energy X-ray absorptiometry.
FM (median (range)) was increased in the patients, 27.76 (19.25-50.24) vs 21.23 (8.81-49.15) kg in the controls (P < 0.005). FM was significantly increased in the arms, legs and trunk in the patients compared with the controls. The proportion of fat deposited centrally did not differ significantly between the two groups (57.0% (47.6-65.1) in the patients vs 55.3% (44.1-63.8) in the controls, P = 0.25). There was an inverse relation between total FM and serum IGFBP-1 present in the patients, p = -0.632, P < 0.005, and in the controls p = -0.467, P < 0.05, but the relation between total FM and area under the GH profile was significant only in the controls (p = -0.651, P < 0.001) and not in the patients. FFM (51.19 (26.96-69.18) kg in the patients vs 51.55 (32.35-60.53) kg in the controls, P = 0.99) and serum IGFBP-1 levels did not differ significantly between the two groups.
Organic growth hormone deficiency causes changes in body composition beyond the changes associated with the ageing process. These changes differ from those seen in younger GH deficient adults in that they are limited to an increase in FM with no change in FFM. These findings indicate that even in the elderly, in whom GH secretion is normally very low, the additional imposition of GH deficiency due to organic disease has significant biological impact.
患有下丘脑 - 垂体疾病的老年患者生长激素（GH）分泌减少，这与因年龄增长导致的GH分泌下降不同。年轻成年人的GH缺乏会导致身体成分发生变化，脂肪量（FM）增加，去脂体重（FFM）减少，这与正常衰老过程中所见相似。本研究的目的是确定老年患者的器质性GH缺乏是否会导致超出衰老所致的身体成分变化。
21例（15例男性）有垂体疾病记录的患者和24例（17例男性）年龄、身高、体重和体重指数（BMI）匹配的对照者，均超过60岁，其GH状态通过24小时GH谱和精氨酸刺激试验确定。
采集血清用于空腹胰岛素样生长因子 - 1（IGF - 1）和胰岛素样生长因子结合蛋白 - 1（IGFBP - 1）测定。使用双能X线吸收法测定全身及局部的FM和FFM。
患者的FM（中位数（范围））增加，患者为27.76（19.25 - 50.24）kg，对照者为21.23（8.81 - 49.15）kg（P < 0.005）。与对照者相比，患者手臂、腿部和躯干的FM显著增加。两组之间中心性脂肪沉积比例无显著差异（患者为57.0%（47.6 - 65.1），对照者为55.3%（44.1 - 63.8），P = 0.25）。患者中总FM与血清IGFBP - 1呈负相关，p = - 0.632，P < 0.005，对照者中p = - 0.467，P < 0.05，但总FM与GH谱下面积之间的关系仅在对照者中显著（p = - 0.651，P < 0.001），在患者中不显著。患者的FFM（51.19（26.96 - 69.18）kg）与对照者的FFM（51.55（32.35 - 60.53）kg）相比，P = 0.99，两组血清IGFBP - 1水平无显著差异。
器质性生长激素缺乏导致的身体成分变化超出了与衰老过程相关的变化。这些变化与年轻的GH缺乏成年人不同，因为它们仅限于FM增加，而FFM无变化。这些发现表明，即使在老年人中，其GH分泌通常非常低，因器质性疾病额外导致的GH缺乏仍具有显著的生物学影响。
