HIZUKA Naomi Tokyo Women's Medical University, School of Medicine Department of Medicine II, Professor, 医学部, 教授 (80147397)
FUKUDA Izumi Tokyo Women's Medical University, School of Medicine Department of Medicine II, Assistant Professor, 医学部, 講師 (80238477)
MURAKAMI Yuko Tokyo Women's Medical University, School of Medicine Department of Medicine II, Clinical Associate, 医学部, 助手 (60318029)
伊東 絵美奈 東京女子医科大学, 医学部, 助手 (20318033)
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¥2,900,000 (Direct Cost : ¥2,900,000)
Fiscal Year 2004 : ¥600,000 (Direct Cost : ¥600,000)
Fiscal Year 2003 : ¥600,000 (Direct Cost : ¥600,000)
Fiscal Year 2002 : ¥1,700,000 (Direct Cost : ¥1,700,000)
In this study, we have investigated pathophysiological significance of growth hormone in adult men as follows.
1.Metabolic disorders in patients with adult growth hormone deficiency and acromegary.
Clinical and biochemical data of patients with adult GHD(AGHD) and acromegaky who attended Tokyo Women's Medical University were analyzed retrospectively from medical records.
In AGHD, diabetes mellitus and impaired glucose tolerance was found in 4 and 16% of the patients, respectively. Forty-two percent of the patients had hypercholesterolemia, 41% had hypertriglyceridemia, 55% had decreased levels of HDL cholesterol. Thirty-five % of the patients had body mass index(BMI) being>25 kg/m^2. Abnormal findings including increased Intima-media thickness(IMT) or plaque being observed in 27 and 20% of the patients. The homeostasis model insulin resistance index(HOMA-R) was 2.87±0.38, suggesting insulin resistance. These data suggest that abnormal lipid and glucose metabolism, and atherosclerotic chan
ges occur frequently in adult patients with GHD. Insulin resistance may play a role in disorders of glucose and lipid metabolism associated with GHD.
In patients with acromegaly, diabetes mellitus and impaired glucose tolerance was found in 45 and 33% of the patients, respectively. Acromegalics had high HOMA-R (3.59±0.56). Serum GH levels in the patients with DM were higher than those in NGT, but, serum IGF-I levels and SDS were not different among the groups. These data suggests that IGF-I might not play the role of glucose metabolism in these patients.
2.Serum levels of adipocytokines in adult growth hormone deficiency and acromegaly
Atherosclerosis and insulin resistance are common complications of adult growth hormone deficiency(GHD) and acromegaly. Circulating adiponectin, an adipocyte-derived protein, has both anti-atherogenic and insulin-sensitising effects. The values of QUICKI as insulin sensitivity index were significantly lower in patients with acromegaly or adult GHD compared to normal subjects (0.33±0.03,0.35±0.04,and 0.36±0.01,respectively). While patients with adult GHD had significantly lower serum adiponectin levels than patients with acromegaly (6.5±3.9,9.2±5.0,P<0.01) these levels were not significantly different from those found in normal subjects (7.8±4.3 μg/ml). There was an inverse correlation between serum adiponectin levels and BMI in both patient groups. However, serum adiponectin levels correlated positively with QUICKI (Rs=0.37,) only in patients with adult GHD. These results demonstrate that adiponectin levels are significantly lower in patients with adult GHD than in patients with acromegaly. Adiponectin levels are similar in patients with GHD and healthy controls, whereas in patients with acromegaly, insulin resistance appears to be not closely related to adiponectin levels compared with BMI. The different relationship between adiponectin and QUICKI observed in the adult GHD and acromegaly groups presumably reflects differences in the mechanisms of insulin resistance under states of GH deficiency or excess.
Serum resistin levels were also investigated in patients with GHD and acromegaly. Less