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School of Rehabilitation Science, McMaster University, Hamilton, Ontario, L8S 1C7 (LJW); Department of Endocrinology, Christie Hospital, Manchester, UK (AM, SMS); Faculty of Medicine, The University of Toronto, Toronto, Ontario M5S 2W6, Canada (SE)
* To whom correspondence should be addressed. E-mail: sezzat{at}mtsinai.on.ca.
The availability of recombinant human growth hormone (GH) and somatostatin analogs provide treatment for adults with GH deficiency (GHD) or excess (acromegaly). Despite being at opposite ends of the spectrum in terms of their GH/insulin-like growth factor -I (GH/IGF-I) axis, both these populations experience overlapping somatic impairments. Adults with untreated GH-deficiency (GHD) have low circulating levels of IGF-I that manifest as altered body composition with increased fat and reduced lean body and skeletal muscle mass. At the other end of the spectrum, adults with GH excess, who have elevated levels of IGF-I, also have altered body composition. Impairments that result from disorders of either GH deficiency or excess are both associated with increased functional limitations, such as reduced ability to walk quickly for prolonged periods, and poorer health-related quality of life (HR-QoL). Adults with untreated GH-deficiency and excess both commonly complain of excessive fatigue that seems to be associated moreso with impaired aerobic than muscular performance.
Several studies have documented that administration of GH or somatostatin analogs to adults with GH deficiency or excess, respectively, ameliorates abnormal biochemical profile and the associated somatic impairments. However, whether these improvements translate into improved physical function in adults with GH deficiency or excess remains largely unknown and their impact on HR-QoL controversial. Review of placebo-controlled trials to date suggests that GH and somatostatin analogs have greater effects on gas exchange and aerobic performance than as an anabolic agent on skeletal muscle mass and function.
Future investigations should include dose-response studies to establish the optimal combination of pharmacological agents plus exercise required to improve not only biochemical markers but also physical function and HR-QoL in adults with GH-deficiency or excess.
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