Growth Hormone Treatment in Adults with Prader Willi Syndrome and GH Deficiency

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Harriette R. Mogul, Phillip D. K. Lee, Barbara Y. Whitman, William B. Zipf, Michael Frey, Susan Myers, Mindy Cahan, Belinda Pinyerd, and A. Louis Southren
Growth Hormone Treatment of Adults with Prader-Willi Syndrome and Growth Hormone Deficiency Improves Lean Body Mass, Fractional Body Fat, and Serum Triiodothyronine without Glucose Impairment: Results from the United States Multicenter Trial
J. Clin. Endocrinol. Metab., Apr 2008; 93: 1238 - 1245.

The purpose of this study was to evaluate the effectiveness and safety of growth hormone (GH) treatment in GH-deficient genotype-positive Prader-Willi syndrome (PWS) adults. Prader-Willi syndrome is a congenital disease that involves obesity, decreased muscle tone, decreased mental capacity, and sex glands that produce little or no hormones. Although, GH replacement in PWS children has well-defined benefits and risks and is used extensively worldwide, the benefits and risks of its use in PWS adults is not as clear.

This 12-month multicenter trial was conducted at outpatient treatment facilities at four U.S. academic medical centers. Thirty eight lean and obese PWS adults were recruited from clinical populations. Human recombinant GH treatment was initiated at a dose of 0.2 mg/d with monthly 0.2-mg increments to a maximum 1.0 mg/d, as tolerated. The study measured lean body mass, percent fat, fasting glucose, hemoglobin, fasting insulin, insulin resistance and serum T3 uptake (thyroid function test).

Lean body mass increased and percent fat decreased at a median final dose of 0.6 mg/d in 30 study subjects who completed 6–12 months of GH. Mean fasting glucose, hemoglobin, fasting insulin, and insulin resistance were normal at baseline in 38 study initiators, including five diabetics, and remained in normal range. Total T3 increased 26.7% with normalization in all subjects including six with baseline T3 values at least 2 SD below the mean. Mildly progressive ankle edema was the most serious treatment related adverse event (five patients).

This study demonstrates that GH improves body composition, normalizes T3, and is well tolerated without glucose impairment in Prader-Willi syndrome genotype adults.



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