Patients were not eligible if they had a recent or current malignancy, craniopharyngioma as cause of hypopituitarism, were planning on becoming pregnant, or had a cardiovascular event within 1 year before recruitment.
Patients were included after oral information and signed informed consent. Blood samples were drawn after an overnight fast prior to every visit. Subjects were tested individually in a sound attenuated room by the same investigator at the same time period of the day. The whole test procedure took about 30 min. A short motor screening task was performed to ensure participants were unimpaired in their ability to respond to the stimuli, and to familiarize them with the computerized procedure.
The performance on the following tests was evaluated: 1 the Pattern Recognition Memory PRM task to investigate visual pattern recognition memory in a 2-choice forced discrimination paradigm. The PRM task involves temporal lobe function [ 40 ].
The outcome measure is the percentage of correctly recalled visual patterns. As these functions are all associated with the frontal area of the brain the SWM is considered to involve frontal lobe function [ 41 , 42 ].
The selected outcome measures were the number of errors made during the test total errors and a score for the use of a strategy. A high strategy score represents poor strategy use [ 43 ]. A shortened Dutch version of 32 items was used for measuring depression, anger, fatigue, tension, and vigor [ 44 ]. Higher scores for depression scores 0—32 , anger scores 0—28 , fatigue scores 0—24 and tension scores 0—24 reflect a negative mood; higher scores for vigor scores 0—20 reflect a better mood.
QoL was assessed by using two different questionnaires, one disease-specific and one general. The general questionnaire was the Nottingham Health Profile NHP , a frequently used health status instrument with 38 dichotomous items that measures physical, emotional, and social distress.
It yields an overall score and sub-section scores physical mobility, energy, pain, emotional reactions, sleep, and social isolation. High scores indicate a poor QoL. Categorical baseline data are expressed as percentage and continuous data as mean SD. Categorical data were analyzed by means of chi square tests and continuous data by means of independent t -tests. For between-group differences for change over time General Linear Model for repeated measures was used with Group HD versus LD and Gender as between subjects factor, and Measurement baseline versus week 24 as repeated measures factor.
If an interaction between Group, Measurement and Gender was observed, separate ANOVAs per gender with Group as between subjects factor and Measurement as repeated measures factor were performed. For the different outcome measures baseline values served as covariates to adjust for regression to the mean. Two sided P values 0. In case of hypotheses with expected results in one direction one-tailed t -tests which is indicated in the text were used.
Between May 31, , and April 11, , we enrolled 32 patients. An invitation was send to 92 eligible patients. Reasons for not participating were lack of time, travel distance, or reluctance to risk deterioration. Table 1 shows the baseline characteristics of the study groups stratified by gender. The groups were mostly comparable, except for two significant differences.
Most prevalent underlying diagnosis of GH deficiency was a pituitary tumor. Off all 13 pituitary tumors, six were a non-secreting adenoma, five a prolactinoma, and two were an ACTH producing adenoma. Other etiologies included radiotherapy for other brain tumors, pituitary apoplexia, empty sella, head trauma, idiopathic, or congenital GH deficiency. The medical history for CVD and diabetes mellitus , smoking habits and alcohol use was similar between all groups.
After start of the study one subject withdrew due to personal reasons. One subject was excluded from the analyses due to the inability to reach the proper IGF-1 target level. The final analyses were conducted with 15 subjects in the LD group and 15 subjects in the HD group. In males, the IGF-1 concentration decreased from In females, the IGF-1 concentration decreased from Figure 1 shows the IGF-1 levels in standard deviation scores SDS during follow up for both treatment regimes stratified by gender.
Table 2 shows the different GH doses stratified by gender before and after follow up. No significant effect was found in males. This result indicates that females in the LD group perform better on the SWM task after 24 weeks of treatment compared to the HD group, and compared to baseline Fig.
This result indicates that females in the LD group perform better on the SWM task after 24 weeks of treatment compared to the HD group. With respect to the PRM test scores no significant results were found. All means SD of the memory tests are summarized in Table 3. With respect to mood scores for Anger, Depression and Tension no significant interaction for Measurement x Group x Gender and Measurement x Group per gender was found. All means SD of the mood scales are shown in Table 3. Thus, females within the LD group show a higher increase in Fatigue after 24 weeks of treatment relative to females in the HD group Fig.
Thus, females within the LD group show a reduced Vigor after 24 weeks of treatment compared to the HD group, and compared to baseline Fig. With respect to QoL outcome scores no significant interaction for Measurement x Group x Gender and Measurement x Group per gender was found. The present study demonstrated that, with respect to cognitive functioning as well as to wellbeing, gender appeared to render different effects of low and high dose GH treatment.
Notably, these effects were not observed in all cognitive domains studied. The PRM subtest is a visual recognition memory task relying on medial temporal lobe functioning. In contrast, the SWM task establishes working memory and strategic memory control, which functions rely on frontal lobe functioning. In the present study no differential effects of the low and high dose GH treatment were found in males nor in females, with respect to PRM.
Therefore, it may be concluded that the change in GH treatment did not specifically affect medial temporal lobe functioning.
In males the low and high dose groups did not have a different effect on SWM, while in females a clear distinction could be made between the effects of the low and the high dose group. Females in the LD group were found to have a better working memory after 24 weeks as opposed to the females in the HD group.
In addition, the females in the LD group showed better strategic memory control after 24 weeks, as opposed to the females in the HD group. These results clearly indicate that in females cognitive performance relying on frontal lobe functioning benefits from a LD GH treatment, but not from an increased GH dose. As a decrease of the previously given dose benefits the cognitive functioning in females, the original dose may have also been too high to be optimal for cognitive function, in particular frontal lobe mediated memory processes.
It may well be true that the IGF-1 levels obtained during long-term GH administration are too high to preserve or improve memory functions, and may even result in memory impairment. In a former study on the cognitive effects of GH treatment in adult survivors of childhood leukaemia, the increase in IGF-1 during the first treatment year was accompanied by a decrease in short-term memory performance. Notably, the decrease in IGF-1 in the second treatment year was accompanied by an improvement of memory performance.
The authors conclude that if the increase in GH-induced IGF-1 levels is too high memory functions may be impaired, whereas this memory impairment may be halted when IGF-1 levels are decreased [ 45 ]. The results of the present study in females seem to have some similarity with those findings.
Thus, the chronically given GH dose may have impaired memory functions, while reducing the dose counteracted the harmful effects on memory function. Human body. Home Endocrine conditions Adult-onset growth hormone deficiency. Adult-onset growth hormone deficiency Adult-onset growth hormone deficiency is where the pituitary gland fails to produce enough growth hormone.
Adult-onset growth hormone deficiency Adult-onset growth hormone deficiency occurs when the pituitary gland fails to produce enough growth hormone. Alternative names for adult-onset growth hormone deficiency Adult growth hormone deficiency syndrome; adult GH deficiency; growth hormone deficiency; GHD What is adult-onset growth hormone deficiency?
What causes adult-onset growth hormone deficiency? Pituitary damage can also result from: radiotherapy to the brain for other tumours close to the pituitary gland or for leukaemia from severe head injury autoimmune disease from interference with the blood supply to the pituitary gland as for example in Sheehan's syndrome , a loss of function of the pituitary gland due to severe blood loss after child birth, or pituitary apoplexy , sudden bleeding in to the pituitary gland.
What are the signs and symptoms of adult-onset growth hormone deficiency? This can lead to an increase in the risk of heart disease abnormalities in the blood and in the circulation osteoporosis brittle bones low energy levels and decreased stamina impaired concentration and memory.
How common is adult-onset growth hormone deficiency? Is adult-onset growth hormone deficiency inherited? How is adult-onset growth hormone deficiency diagnosed? How is adult-onset growth hormone deficiency treated? Are there any side-effects to the treatment? Taking growth hormone will not cause any increase in height in adults. What are the longer-term implications of adult-onset growth hormone deficiency?
Are there patient support groups for people with adult-onset growth hormone deficiency? Last reviewed: Jan Prev. With this condition, the body is not sensitive to GH due to a change mutation to the growth hormone receptor gene.
This results in short stature dwarfism. Test results may vary depending on your age, gender, health history, the method used for the test, and other things. Your test results may not mean you have a problem. Ask your healthcare provider what your test results mean for you. IGF-1 measurements are adjusted for age because levels tend to decrease after puberty as you get older. Normal ranges vary by age. The test is done with a blood sample. A needle is used to draw blood from a vein in your arm or hand.
Will I need to do anything to prepare for this test? You don't need any special preparations for an IGF-1 test. Are there any risks to this test? What do the results mean? Is there anything else I need to know about an IGF-1 test?
References Hormone Health Network [Internet]. Endocrine Society; c Acromegaly; [updated Apr; cited Apr 5]; [about 3 screens]. Growth Hormone Deficiency; [updated Nov; cited Apr 5]; [about 3 screens]. Mayo Foundation for Medical Education and Research; c— Acromegaly: Diagnosis and treatment; Feb 16 [cited Apr 5]; [about 4 screens].
Acromegaly: Symptoms and causes; Feb 16 [cited Apr 5]; [about 3 screens]. Gaithersburg MD : U. Bethesda MD : U. Growth Hormone Deficiency; [cited Apr 5]; [about 3 screens].
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