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Aguiar-Oliveira MH, Salvatori R. The state of Sergipe contribution to GH research: from Souza Leite to Itabaianinha syndrome. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2022; 66:919-928. [PMID: 36394485 PMCID: PMC10118753 DOI: 10.20945/2359-3997000000567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In the late 19th century, José Dantas de Souza Leite, a physician born in Sergipe, published the first detailed clinical description of acromegaly under the guidance of the French neurologist Pierre Marie. In 2014, the Brazilian Society of Endocrinology and Metabolism created the "José Dantas de Souza Leite Award", which is granted every two years to a Brazilian researcher who has contributed to the development of endocrinology. In 2022, the award was given to another physician from Sergipe, Manuel Hermínio de Aguiar Oliveira, from the Federal University of Sergipe for the description of "Itabaianinha syndrome" in a cohort of individuals with isolated GH deficiency due to a homozygous inactivating mutation in the GH-releasing hormone receptor gene. This research, which was carried out over almost 30 years, was performed in partnership with Roberto Salvatori from Johns Hopkins University and in collaboration with other researchers around the world. This review article tells the story of Souza Leite, some milestones in the history of GH, and summarizes the description of Itabaianinha syndrome.
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Aguiar-Oliveira MH, Salvatori R. Disruption of the GHRH receptor and its impact on children and adults: The Itabaianinha syndrome. Rev Endocr Metab Disord 2021; 22:81-89. [PMID: 32935264 DOI: 10.1007/s11154-020-09591-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2020] [Indexed: 12/22/2022]
Abstract
Since 1994, we have been studying an extended kindred with 105 subjects (over 8 generations) residing in Itabaianinha County, in the Brazilian state of Sergipe, who have severe isolated GH deficiency (IGHD) due to a homozygous inactivating mutation (c.57 + 1G > A) in the GH releasing hormone (GHRH) receptor (GHRHR) gene. Most of these individuals have never received GH replacement therapy. They have low GH, and very low and often undetectable levels of serum IGF-I. Their principal physical findings are proportionate short stature, doll facies, high-pitched-voice, central obesity, wrinkled skin, and youthful hair with delayed pigmentation, and virtual absence of graying. The newborns from this cohort are of normal size, indicating that GH is not needed for intra-uterine growth. However, these IGHD individuals exhibit a myriad of phenotypic changes throughout the body, with a greater number of beneficial than harmful consequences. This GHRH signal disruption syndrome has been a valuable model to study the GH roles in body size and function. This reviews summarized the findings we have reported on this cohort.
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Affiliation(s)
- Manuel H Aguiar-Oliveira
- Division of Endocrinology, University Hospital, Federal University of Sergipe, Rua Claudio Batista s/n, Aracaju, Sergipe, 49060-100, Brazil.
| | - Roberto Salvatori
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Johns Hopkins University School of Medicine Baltimore, Baltimore, MD, 21287, USA
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Barrios MR, Campos VC, Peres NTA, de Oliveira LL, Cazzaniga RA, Santos MB, Aires MB, Silva RLL, Barreto A, Goto H, Almeida RP, Salvatori R, Aguiar-Oliveira MH, Jesus AMR. Macrophages From Subjects With Isolated GH/IGF-I Deficiency Due to a GHRH Receptor Gene Mutation Are Less Prone to Infection by Leishmania amazonensis. Front Cell Infect Microbiol 2019; 9:311. [PMID: 31544067 PMCID: PMC6730494 DOI: 10.3389/fcimb.2019.00311] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 08/16/2019] [Indexed: 01/06/2023] Open
Abstract
Isolated growth hormone (GH) deficiency (IGHD) affects approximately 1 in 4,000 to 1 in 10,000 individuals worldwide. We have previously described a large cohort of subjects with IGHD due to a homozygous mutation in the GH releasing hormone (GHRH) receptor gene. These subjects exhibit throughout the life very low levels of GH and its principal mediator, the Insulin Growth Factor-I (IGF-I). The facilitating role of IGF-I in the infection of mouse macrophages by different Leishmania strains is well-known. Nevertheless, the role of IGF-I in Leishmania infection of human macrophages has not been studied. This study aimed to evaluate the behavior of Leishmania infection in vitro in macrophages from untreated IGHD subjects. To this end, blood samples were collected from 14 IGHD individuals and 14 age and sex-matched healthy controls. Monocytes were isolated and derived into macrophages and infected with a strain of Leishmania amazonensis. In addition, IGF-I was added to culture medium to evaluate its effect on the infection. Cytokines were measured in the culture supernatants. We found that macrophages from IGHD subjects were less prone to Leishmania infection compared to GH sufficient controls. Both inflammatory and anti-inflammatory cytokines increase only in the supernatants of the control macrophages. Addition of IGF-I to the culture medium increased infection rates. In conclusion, we demonstrated that IGF-I is crucial for Leishmania infection of human macrophages.
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Affiliation(s)
- Mônica R Barrios
- Division of Immunology and Molecular Biology Laboratory, Federal University of Sergipe, Aracaju, Brazil
| | - Viviane C Campos
- Division of Endocrinology, Federal University of Sergipe, Aracaju, Brazil
| | - Nalu T A Peres
- Division of Immunology and Molecular Biology Laboratory, Federal University of Sergipe, Aracaju, Brazil.,Department of Microbiology, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Laís L de Oliveira
- Division of Immunology and Molecular Biology Laboratory, Federal University of Sergipe, Aracaju, Brazil
| | - Rodrigo A Cazzaniga
- Division of Immunology and Molecular Biology Laboratory, Federal University of Sergipe, Aracaju, Brazil
| | - Márcio B Santos
- Division of Immunology and Molecular Biology Laboratory, Federal University of Sergipe, Aracaju, Brazil
| | - Murilo B Aires
- Division of Immunology and Molecular Biology Laboratory, Federal University of Sergipe, Aracaju, Brazil
| | - Ricardo L L Silva
- Division of Immunology and Molecular Biology Laboratory, Federal University of Sergipe, Aracaju, Brazil
| | - Aline Barreto
- Division of Immunology and Molecular Biology Laboratory, Federal University of Sergipe, Aracaju, Brazil
| | - Hiro Goto
- Laboratório de Soroepidemiologia e Imunobiologia, Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, Brazil.,Division of Endocrinology, Diabetes and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Roque P Almeida
- Division of Immunology and Molecular Biology Laboratory, Federal University of Sergipe, Aracaju, Brazil
| | - Roberto Salvatori
- Division of Endocrinology, Diabetes and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | | | - Amélia M R Jesus
- Division of Immunology and Molecular Biology Laboratory, Federal University of Sergipe, Aracaju, Brazil
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Stojanovic M, Wu Z, Stiles CE, Miljic D, Soldatovic I, Pekic S, Doknic M, Petakov M, Popovic V, Strasburger C, Korbonits M. Circulating aryl hydrocarbon receptor-interacting protein (AIP) is independent of GH secretion. Endocr Connect 2019; 8:326-337. [PMID: 30830858 PMCID: PMC6432870 DOI: 10.1530/ec-19-0082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 03/04/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Aryl hydrocarbon receptor-interacting protein (AIP) is evolutionarily conserved and expressed widely throughout the organism. Loss-of-function AIP mutations predispose to young-onset pituitary adenomas. AIP co-localizes with growth hormone in normal and tumorous somatotroph secretory vesicles. AIP protein is detectable in circulation. We aimed to investigate possible AIP and GH co-secretion, by studying serum AIP and GH levels at baseline and after GH stimulation or suppression, in GH deficiency (GHD) and in acromegaly patients. SUBJECTS AND METHODS Insulin tolerance test (ITT) was performed in GHD patients (n = 13) and age-BMI-matched normal GH axis control patients (n = 31). Oral glucose tolerance test (OGTT) was performed in active acromegaly patients (n = 26) and age-BMI-matched normal GH axis control patients (n = 18). In-house immunometric assay was developed for measuring circulating AIP. RESULTS Serum AIP levels were in the 0.1 ng/mL range independently of gender, age or BMI. Baseline AIP did not differ between GHD and non-GHD or between acromegaly and patients with no acromegaly. There was no change in peak, trough or area under the curve during OGTT or ITT. Serum AIP did not correlate with GH during ITT or OGTT. CONCLUSIONS Human circulating serum AIP in vivo was assessed by a novel immunometric assay. AIP levels were independent of age, sex or BMI and unaffected by hypoglycaemia or hyperglycaemia. Despite co-localization in secretory vesicles, AIP and GH did not correlate at baseline or during GH stimulation or suppression tests. A platform of reliable serum AIP measurement is established for further research of its circulatory source, role and impact.
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Affiliation(s)
- Marko Stojanovic
- Neuroendocrinology Department, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Belgrade, Serbia
- University of Belgrade, Medical Faculty, Belgrade, Serbia
| | - Zida Wu
- Department of Medicine for Endocrinology, Diabetes and Nutritional Medicine, Charité Universitätsmedizin, Campus Mitte, Berlin, Germany
| | - Craig E Stiles
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Dragana Miljic
- Neuroendocrinology Department, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Belgrade, Serbia
- University of Belgrade, Medical Faculty, Belgrade, Serbia
| | - Ivan Soldatovic
- University of Belgrade, Medical Faculty, Belgrade, Serbia
- Insitute of Medical Statistics and Informatics, Belgrade, Serbia
| | - Sandra Pekic
- Neuroendocrinology Department, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Belgrade, Serbia
- University of Belgrade, Medical Faculty, Belgrade, Serbia
| | - Mirjana Doknic
- Neuroendocrinology Department, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Belgrade, Serbia
- University of Belgrade, Medical Faculty, Belgrade, Serbia
| | - Milan Petakov
- Neuroendocrinology Department, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Belgrade, Serbia
- University of Belgrade, Medical Faculty, Belgrade, Serbia
| | - Vera Popovic
- University of Belgrade, Medical Faculty, Belgrade, Serbia
| | - Christian Strasburger
- Department of Medicine for Endocrinology, Diabetes and Nutritional Medicine, Charité Universitätsmedizin, Campus Mitte, Berlin, Germany
| | - Márta Korbonits
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Aguiar-Oliveira MH, Bartke A. Growth Hormone Deficiency: Health and Longevity. Endocr Rev 2019; 40:575-601. [PMID: 30576428 PMCID: PMC6416709 DOI: 10.1210/er.2018-00216] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 12/07/2018] [Indexed: 12/13/2022]
Abstract
The important role of GH in the control of mammalian longevity was first deduced from extended longevity of mice with genetic GH deficiency (GHD) or GH resistance. Mice with isolated GHD (IGHD) due to GHRH or GHRH receptor mutations, combined deficiency of GH, prolactin, and TSH, or global deletion of GH receptors live longer than do their normal siblings. They also exhibit multiple features of delayed and/or slower aging, accompanied by extension of healthspan. The unexpected, remarkable longevity benefit of severe endocrine defects in these animals presumably represents evolutionarily conserved trade-offs among aging, growth, maturation, fecundity, and the underlying anabolic processes. Importantly, the negative association of GH signaling with longevity extends to other mammalian species, apparently including humans. Data obtained in humans with IGHD type 1B, owing to a mutation of the GHRH receptor gene, in the Itabaianinha County, Brazil, provide a unique opportunity to study the impact of severe reduction in GH signaling on age-related characteristics, health, and functionality. Individuals with IGHD are characterized by proportional short stature, doll facies, high-pitched voices, and central obesity. They have delayed puberty but are fertile and generally healthy. Moreover, these IGHD individuals are partially protected from cancer and some of the common effects of aging and can attain extreme longevity, 103 years of age in one case. We think that low, but detectable, residual GH secretion combined with life-long reduction of circulating IGF-1 and with some tissue levels of IGF-1 and/or IGF-2 preserved may account for the normal longevity and apparent extension of healthspan in these individuals.
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Affiliation(s)
| | - Andrzej Bartke
- Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois
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Aguiar-Oliveira MH, Davalos C, Campos VC, Oliveira Neto LA, Marinho CG, Oliveira CRP. Hypothalamic abnormalities: Growth failure due to defects of the GHRH receptor. Growth Horm IGF Res 2018; 38:14-18. [PMID: 29277338 DOI: 10.1016/j.ghir.2017.12.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 12/19/2017] [Accepted: 12/19/2017] [Indexed: 12/16/2022]
Abstract
Several acquired or congenital hypothalamic abnormalities may cause growth failure (GF). We described two of these congenital abnormalities. First, a case of CHARGE syndrome, an epigenetic disorder mostly caused by heterozygous mutations in the gene encoding CHD7, a chromatin remodeling protein, causing several malformations, some life-threatening, with additional secondary hypothalamus-hypophyseal dysfunction, including GF. Second, a cohort of individuals with genetic isolated severe GH deficiency (IGHD), due to a homozygous mutation in the GH-releasing hormone (GHRH) receptor gene described in Itabaianinha County, in northeast Brazil. In this IGHD, with marked reduction of serum concentrations of IGF-I, and an up regulation of IGF-II, GF is the principal finding in otherwise normal subjects, with normal quality of life and longevity. This IGHD may unveil the effects of GHRH, pituitary GH and IGF-I, IGF-II and local GH and growth factor on the size and function of body and several systems. For instance, anterior pituitary hypoplasia, and impairment of the non-REM sleep may be due to GHRH resistance. Proportionate short stature, doll facies, high-pitched pre-pubertal voice, and reduced muscle mass reflect the lack of the synergistic effect of pituitary GH and IGF-I in bones and muscles. Central adiposity may be due to a direct effect of the lack of GH. Brain, eyes and immune system may also involve IGF-II and local GH or growth factors. A concept of physiological hierarchy controlling body size and function by each component of the GH system may be drawn from this model.
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Affiliation(s)
- Manuel H Aguiar-Oliveira
- Division of Endocrinology, Department of Medicine, Federal University of Sergipe, 49060-100, Aracaju, Sergipe, Brazil.
| | - Caridad Davalos
- Division of Pediatrics, Pediatric Critical Care, Hospital Pediatrico Baca Ortiz, Universidad San Francisco de Quito, 1712-841 Quito, Ecuador
| | - Viviane C Campos
- Division of Endocrinology, Department of Medicine, Federal University of Sergipe, 49060-100, Aracaju, Sergipe, Brazil
| | - Luiz A Oliveira Neto
- Department of Orthodontics, School of Dentistry, Federal University of Sergipe, 49060-100 Aracaju, Sergipe, Brazil
| | - Cindi G Marinho
- Division of Endocrinology, Department of Medicine, Federal University of Sergipe, 49060-100, Aracaju, Sergipe, Brazil
| | - Carla R P Oliveira
- Division of Endocrinology, Department of Medicine, Federal University of Sergipe, 49060-100, Aracaju, Sergipe, Brazil
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Faro ACN, Pereira-Gurgel VM, Salvatori R, Campos VC, Melo GB, Oliveira FT, Oliveira-Santos AA, Oliveira CRP, Pereira FA, Hellström A, Oliveira-Neto LA, Valença EHO, Aguiar-Oliveira MH. Ocular findings in adult subjects with an inactivating mutation in GH releasing hormone receptor gene. Growth Horm IGF Res 2017; 34:8-12. [PMID: 28456063 DOI: 10.1016/j.ghir.2017.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 02/28/2017] [Accepted: 04/19/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Ocular function is fundamental for environmental adaptation and survival capacity. Growth factors are necessary for a mature eyeball, needed for adequate vision. However, the consequences of the deficiency of circulating growth hormone (GH) and its effector insulin-like growth factor I (IGF-I) on the physical aspects of the human eye are still debated. A model of untreated isolated GH deficiency (IGHD), with low but measurable serum GH, may clarify this issue. The aim of this study was to assess the ocular aspects of adult IGHD individuals who have never received GH therapy. DESIGN Cross sectional study. METHODS Setting: University Hospital, Federal University of Sergipe, Brazil. PATIENTS Twenty-five adult (13 males, mean age 50.1years, range 26 to 70years old) IGHD subjects homozygous for a null mutation (c.57+1G>A) in the GHRH receptor gene, and 28 (15 males, mean age 51.1years, range 26 to 67years old) controls were submitted to an endocrine and ophthalmological assessment. Forty-six IGHD and 50 control eyes were studied. MAIN OUTCOME MEASURES Visual acuity, intraocular pressure, refraction (spherical equivalent), ocular axial length (AL), anterior chamber depth (ACD), lens thickness (LT), vitreous depth (VD), mean corneal curvature (CC) and central corneal thickness (CCT). RESULTS IGHD subjects exhibited unmeasurable serum IGF-I levels, similar visual acuity, intraocular pressure and LT, higher values of spherical equivalent and CC, and lower measures of AL, ACD, VD and CCT in comparison to controls, but within their respective normal ranges. While mean stature in IGHD group was 78% of the control group, mean head circumference was 92% and axial AL was 96%. CONCLUSIONS These observations suggest mild ocular effects in adult subjects with severe IGF-I deficiency due to non-treated IGHD.
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Affiliation(s)
- Augusto C N Faro
- Division of Ophthalmology, Federal University of Sergipe, Aracaju, SE, Brazil
| | | | - Roberto Salvatori
- Division of Endocrinology, Diabetes and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Viviane C Campos
- Division of Endocrinology, Federal University of Sergipe, Aracaju, SE, Brazil
| | | | | | | | - Carla R P Oliveira
- Division of Endocrinology, Federal University of Sergipe, Aracaju, SE, Brazil
| | - Francisco A Pereira
- Division of Endocrinology, Federal University of Sergipe, Aracaju, SE, Brazil
| | - Ann Hellström
- Sahlgrenska Academy, The Queen Silvia Children's Hospital, Göteborg, Sweden
| | | | - Eugenia H O Valença
- Division of Speech Therapy, Federal University of Sergipe, Aracaju, SE, Brazil
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Campos VC, Barrios MR, Salvatori R, de Almeida RP, de Melo EV, Nascimento ACS, de Jesus AR, Aguiar-Oliveira MH. Infectious diseases and immunological responses in adult subjects with lifetime untreated, congenital GH deficiency. Endocrine 2016; 54:182-190. [PMID: 27484773 DOI: 10.1007/s12020-016-1061-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 07/12/2016] [Indexed: 12/30/2022]
Abstract
Growth hormone is important for the development and function of the immune system, but there is controversy on whether growth hormone deficiency is associated to immune disorders. A model of isolated growth hormone deficiency may clarify if the lack of growth hormone is associated with increased susceptibility to infections, or with an altered responsiveness of the immune system. We have studied the frequency of infectious diseases and the immune function in adults with congenital, untreated isolated growth hormone deficiency. In a cross-sectional study, 35 adults with isolated growth hormone deficiency due to a homozygous mutation in the growth hormone releasing hormone receptor gene and 31 controls were submitted to a clinical questionnaire, physical examination serology for tripanosomiasis, leishmaniasis, HIV, tetanus, hepatitis B and C, and serum total immunoglobulin G, M, E and A measurement. The immune response was evaluated in a subset of these subjects by skin tests and response to vaccination for hepatitis B, tetanus, and bacillus Calmette-Guérin. There was no difference between the groups in history of infectious diseases and baseline serology. Isolated growth hormone deficiency subjects had lower total IgG, but within normal range. There was no difference in the response to any of the vaccinations or in the positivity to protein Purified Derived, streptokinase or candidin. Adult untreated isolated growth hormone deficiency does not cause an increased frequency of infectious diseases, and does not alter serologic tests, but is associated with lower total IgG levels, without detectable clinical impact.
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Affiliation(s)
- Viviane C Campos
- Federal University of Sergipe, Division of Endocrinology, Aracaju, Sergipe, 49060-100, Brazil
| | - Mônica R Barrios
- Federal University of Sergipe, Division of Immunology and Molecular Biology Laboratory, Aracaju, Sergipe, 49060-100, Brazil
| | - Roberto Salvatori
- Division of Endocrinology, Diabetes and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
| | - Roque Pacheco de Almeida
- Federal University of Sergipe, Division of Immunology and Molecular Biology Laboratory, Aracaju, Sergipe, 49060-100, Brazil
| | - Enaldo V de Melo
- Federal University of Sergipe, Division of Endocrinology, Aracaju, Sergipe, 49060-100, Brazil
| | - Ana C S Nascimento
- Federal University of Sergipe, Division of Endocrinology, Aracaju, Sergipe, 49060-100, Brazil
| | - Amélia Ribeiro de Jesus
- Federal University of Sergipe, Division of Immunology and Molecular Biology Laboratory, Aracaju, Sergipe, 49060-100, Brazil
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Oliveira-Santos AA, Salvatori R, Gomes-Santos E, Santana JAM, Leal ÂCGB, Barbosa RAA, Oliveira CRP, Souza AHO, Valença EHO, Aguiar-Oliveira MH. Subjects with isolated GH deficiency due to a null GHRHR mutation eat proportionally more, but healthier than controls. Endocrine 2016; 51:317-22. [PMID: 26100788 DOI: 10.1007/s12020-015-0670-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 06/16/2015] [Indexed: 11/25/2022]
Abstract
The GH/IGF-I axis has important interactions with the alimentary system and with the balance between energy intake (EI) and energy requirement (ER). Reduced EI has been described in adult-onset acquired GH deficiency (GHD). Individuals from the Brazilian Itabaianinha cohort, with isolated GHD (IGHD) due to a homozygous mutation (c.57+1G→A) in the GHRH receptor gene, are an ideal model to study the consequences of lifetime GHD. The purpose of this study is to evaluate EI and ER in this untreated IGHD cohort. Cross-sectional study of 24 adult IGHD patients and 23 controls from the same region, matched for age and gender. Estimated EI (EEI) was evaluated by dietary recall, and estimated ER (EER) by the equation of the Dietary Reference Intakes. Fat mass was assessed by DXA. Both EEI and EER were lower in IGHD than controls. However, when corrected by body weight, EEI was higher in IGHD (p = 0.005). IGHD individuals consume in percentage more proteins (p < 0.0001), less carbohydrates (p = 0.013), and equal amount of lipids in comparison to controls. The higher EEI per body weight suggests a possible increase of orexigenic mechanisms in untreated IGHD individuals, ensuring greater caloric intake, which would have adaptive advantages for small-sized individuals in environments with limited access to food. IGHD individuals seem to have a healthier dietary pattern than CO.
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Affiliation(s)
| | - Roberto Salvatori
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, 1830 East Monument Street Suite #333, Baltimore, MD, 21287, USA.
| | - Elenilde Gomes-Santos
- Division of Endocrinology, Federal University of Sergipe, Aracaju, SE, 49060-100, Brazil
| | - João A M Santana
- Division of Endocrinology, Federal University of Sergipe, Aracaju, SE, 49060-100, Brazil
| | - Ângela C G B Leal
- Division of Endocrinology, Federal University of Sergipe, Aracaju, SE, 49060-100, Brazil
| | - Rita A A Barbosa
- Division of Endocrinology, Federal University of Sergipe, Aracaju, SE, 49060-100, Brazil
| | - Carla R P Oliveira
- Division of Endocrinology, Federal University of Sergipe, Aracaju, SE, 49060-100, Brazil
| | - Anita H O Souza
- Division of Endocrinology, Federal University of Sergipe, Aracaju, SE, 49060-100, Brazil
| | - Eugênia H O Valença
- Division of Endocrinology, Federal University of Sergipe, Aracaju, SE, 49060-100, Brazil
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Gomes-Santos E, Salvatori R, Ferrão TO, Oliveira CRP, Diniz RDCA, Santana JAM, Pereira FA, Barbosa RAA, Souza AHO, Melo EV, Epitácio-Pereira CC, Oliveira-Santos AA, Oliveira IAS, Machado JA, Santana-Júnior FJ, Barreto-Filho JAS, Aguiar-Oliveira MH. Increased visceral adiposity and cortisol to cortisone ratio in adults with congenital lifetime isolated GH deficiency. J Clin Endocrinol Metab 2014; 99:3285-9. [PMID: 24926956 DOI: 10.1210/jc.2014-2132] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Adult-onset GH deficiency (GHD) increases visceral adiposity and the activity of the enzyme 11β-hydroxysteroid dehydrogenase, which converts cortisone (E) to cortisol (F), both linked to insulin resistance and increased cardiovascular risk. Conversely, we reported that adults with congenital isolated GHD (IGHD) have increased insulin sensitivity. OBJECTIVE To assess the type of fat distribution and the amount of visceral and sc fat and to correlate them to the F/E ratio in adults with untreated IGHD due to a mutation in the GHRH receptor gene. METHODS Body composition was assessed by dual-energy x-ray absorptiometry, thickness of sc and visceral fat was measured by sonography, and serum F and E were measured in 23 IGHD subjects and 21 age-matched controls. RESULTS Waist/hip ratio (WHR), trunk fat, and trunk/extremity fat (TR/EXT) ratio were higher in IGHD subjects. Visceral fat index (VFI) (but not sc fat index [SFI]) was higher in IGHD. F and F/E ratio were also higher in IGHD. In all 44 individuals, WHR correlated with TR/EXT ratio, thickness of visceral fat, VFI/SFI ratio, F, and F/E ratio. TR/EXT ratio correlated with visceral fat thickness, VFI/SFI ratio, and F. Age had a significant effect on VFI and on F/E ratio. Body mass index SD score and WHR have a similar significant effect on TR/EXT ratio and on F/E ratio. CONCLUSIONS Lifetime congenital untreated IGHD causes increased visceral adiposity with a high F/E ratio. However, the increased insulin sensitivity suggests that visceral adiposity needs a minimal GH secretion to translate into increased insulin resistance.
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Affiliation(s)
- Elenilde Gomes-Santos
- Federal University of Sergipe, Divisions of Endocrinology (E.G.-S., C.R.P.O., R.D.C.A.D., J.A.M.S., F.A.P., R.A.A.B. A.H.O.S., E.V.M., C.C.E.-P., A.A.O.-S., I.A.S.O., J.A.M., F.J.S.-J., J.A.S.B.-F., M.H.A.-O.), and Radiology (T.O.F.), Aracaju, SE, Brazil 49060-100; and Division of Endocrinology, Diabetes, and Metabolism (R.S.), The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287
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Vicente TAR, Rocha ÍES, Salvatori R, Oliveira CRP, Pereira RMC, Souza AHO, Campos VC, Santos EG, Diniz RDCA, Valença EHO, Epitácio-Pereira CC, Oliveira MCP, Mari A, Aguiar-Oliveira MH. Lifetime congenital isolated GH deficiency does not protect from the development of diabetes. Endocr Connect 2013; 2:112-7. [PMID: 23795286 PMCID: PMC3689269 DOI: 10.1530/ec-13-0014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 05/17/2013] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Adult subjects with untreated, lifetime, isolated GH deficiency (IGHD) due to a homozygous GHRH receptor gene mutation (MUT/MUT) residing in Itabaianinha, Brazil, present with lower BMI, higher prevalence of impaired glucose tolerance (IGT), increased insulin sensitivity (IS), and reduced β-cell function (βCF) when compared with non-BMI-matched homozygous normal controls. However, the prevalence of diabetes mellitus (DM) in this cohort is unknown. Comparing their IS and βCF with BMI-matched individuals heterozygous for the same mutation (MUT/N) may be useful to elucidate the role of the GH-IGF1 axis in IS and βCF. The purposes of this work were to verify the prevalence of IGT and DM in adult MUT/MUT subjects from this kindred and to compare IS and βCF in MUT/MUT and MUT/N. DESIGN Cross-sectional study. METHODS We studied most (51) of the living IGHD adults of this kindred who are GH naive. The oral glucose tolerance test (OGTT) could be performed in 34 subjects, fasting glucose was measured in 15, while two had a previous diagnosis of DM. The OGTT results of 24 MUT/MUT subjects were compared with those of 25 BMI-matched MUT/N subjects. IS was assessed by homeostatic model assessment of insulin resistance (HOMA-IR), quantitative IS check index, and oral glucose IS index for 2 and 3 h. βCF was assayed by HOMA-β, insulinogenic index, and the area under the curve of insulin:glucose ratio. RESULTS The prevalence of DM and IGT in IGHD was 15.68 and 38.23% respectively. IS was increased and βCF was reduced in MUT/MUT in comparison with MUT/N. CONCLUSIONS Lifetime, untreated IGHD increases IS, impairs βCF, and does not provide protection from diabetes.
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Affiliation(s)
| | | | - Roberto Salvatori
- Division of EndocrinologyThe Johns Hopkins University School of Medicine1830 East Monument Street, Suite #333, Baltimore, Maryland, 21287USA
- Correspondence should be addressed to R Salvatori
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Oliveira-Neto LA, Melo MDFB, Franco AA, Oliveira AHA, Souza AHO, Valença EHO, Britto IMPA, Salvatori R, Aguiar-Oliveira MH. Cephalometric features in isolated growth hormone deficiency. Angle Orthod 2011; 81:578-83. [PMID: 21341997 DOI: 10.2319/102210-618.1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To analyze cephalometric features in adults with isolated growth hormone (GH) deficiency (IGHD). MATERIALS AND METHODS Nine adult IGHD individuals (7 males and 2 females; mean age, 37.8 ± 13.8 years) underwent a cross-sectional cephalometric study, including 9 linear and 5 angular measurements. Posterior facial height/anterior facial height and lower-anterior facial height/anterior facial height ratios were calculated. To pool cephalometric measurements in both genders, results were normalized by standard deviation scores (SDS), using the population means from an atlas of the normal Brazilian population. RESULTS All linear measurements were reduced in IGHD subjects. Total maxillary length was the most reduced parameter (-6.5 ± 1.7), followed by a cluster of six measurements: posterior cranial base length (-4.9 ± 1.1), total mandibular length (-4.4 ± 0.7), total posterior facial height (-4.4 ± 1.1), total anterior facial height (-4.3 ± 0.9), mandibular corpus length (-4.2 ± 0.8), and anterior cranial base length (-4.1 ± 1.7). Less affected measurements were lower-anterior facial height (-2.7 ± 0.7) and mandibular ramus height (-2.5 ± 1.5). SDS angular measurements were in the normal range, except for increased gonial angle (+2.5 ± 1.1). Posterior facial height/anterior facial height and lower-anterior facial height/anterior facial height ratios were not different from those of the reference group. CONCLUSIONS Congenital, untreated IGHD causes reduction of all linear measurements of craniofacial growth, particularly total maxillary length. Angular measurements and facial height ratios are less affected, suggesting that lGHD causes proportional blunting of craniofacial growth.
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