The Influence of Growth Hormone Status on Physical Impairments, Functional Limitations, and Health-Related Quality of Life in Adults
Linda J. Woodhouse,
Annice Mukherjee,
Stephen M. Shalet and
Shereen Ezzat
School of Rehabilitation Science (L.J.W.), McMaster University, Hamilton, Ontario, Canada L8S 1C7; Department of Endocrinology (A.M., S.M.S.), Christie Hospital, Manchester M20 4BX, United Kingdom; and Faculty of Medicine (S.E.), The University of Toronto, Toronto, Ontario, Canada M5S 2W6
Correspondence: Address all correspondence and requests for reprints to: Dr. S. Ezzat, University of Toronto, Mt. Sinai Hospital, 600 University Avenue, No. 437, Toronto, Ontario, Canada M5G-1X5. E-mail: sezzat{at}mtsinai.on.ca
The availability of recombinant human GH and somatostatin analogshas resulted in widespread treatment for adults with GH deficiency(GHD) and those with GH excess (acromegaly). Despite being atopposite ends of the spectrum in terms of their GH/IGF-I axis,both of these populations experience overlapping somatic impairments.Adults with untreated GHD have low circulating levels of IGF-Ithat manifest as altered body composition with increased fatand reduced lean body and skeletal muscle mass. At the otherend of the spectrum, adults with GH excess, who have elevatedlevels of IGF-I, also have altered body composition. Impairmentsthat result from disorders of either GHD or GH excess are bothassociated with increased functional limitations, such as reducedability to walk quickly for prolonged periods, and poorer health-relatedquality of life (HR-QoL). Adults with untreated GHD and GH excessboth commonly complain of excessive fatigue that seems to beassociated more with impaired aerobic than muscular performance.
Several studies have documented that administration of GH orsomatostatin analogs to adults with GHD or GH excess, respectively,ameliorates abnormal biochemical profile and the associatedsomatic impairments. However, whether these improvements translateinto improved physical function in adults with GHD or GH excessremains largely unknown, and their impact on HR-QoL controversial.Review of placebo-controlled trials to date suggests that GHand somatostatin analogs have greater effects on gas exchangeand aerobic performance than as anabolic agents on skeletalmuscle mass and function.
Future investigations should include dose-response studies toestablish the optimal combination of pharmacological agentsplus exercise required to improve not only biochemical markersbut also physical function and HR-QoL in adults with GHD orGH excess.
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