Vascular function and intima-media thickness in children and adolescents with growth hormone deficiency: results from a prospective case-control study.

Background: Growth hormone deficiency (GHD) may be associated with subtle cardiovascular abnormalities, reversible upon starting GH treatment. Data on vascular morphology and function in GHD children are scanty and inconclusive. Objective: To evaluate the effects of GHD and GH treatment on endothelial function and intima-media thickness (IMT) in children and adolescents. Methods: We enrolled 24 children with GHD (10.85 +/- 2.71 years) and 24 age-, sex- and BMI-matched controls. We evaluated anthropometry, lipid profile, asymmetric dimethylarginine (ADMA), brachial flow-mediated dilatation (FMD) and IMT of common (cIMT) and internal carotid artery (iIMT) at study entry in all subjects and after 12 months of treatment in GHD children.Results: At baseline GHD children had higher total (163.17 +/- 18.66 vs 149.83 +/- 20.68 mg/dl, p=0.03), LDL cholesterol (91.18 +/- 20.41 vs 77.08 +/- 19.73 mg/dl, p=0.019), atherogenic index (AI) (2.94 +/- 0.71 vs 2.56 +/- 0.4, p=0.028), and ADMA (215.87 +/- 109.15 vs 164.10 +/- 49.15 ng/ml, p<0.001), compared to controls. GHD patients also exhibited increased higher waist-to-height ratio (WhtR) compared to controls (0.48 +/- 0.05 vs 0.45 +/- 0.02cm, p=0.03) GH therapy resulted in a decrease in WhtR (0.44 +/- 0.03 cm, p=0.001), total (151.60 +/- 15.23 mg/dl, p=0.001) and LDL cholesterol (69.94 +/- 14.40 mg/dl, p<0.0001), AI (2.28 +/- 0.35, p=0.001), and ADMA (148.47 +/- 102.43 ng/ml, p<0.0001).GHD showed lower baseline FMD than controls (8.75 +/- 2.44 vs 11.85 +/- 5.98%; p=0.001), which improved after 1-year GH treatment (10.60 +/- 1.69%, p=0.001). Baseline cIMT and iIMT were comparable between the two groups, but slightly reduced in GHD patients after treatment. Conclusions: GHD children may exhibit endothelial dysfunction in addition to other early atherosclerotic markers like visceral adiposity, and altered lipids, which can be restored by GH treatment.