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.