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Acquired growth hormone resistance in patients with chronic heart failure: implications for therapy with growth hormone

Stefan D. Anker, MD, PhD^* , Maurizio Volterrani, MD, Claus-Dieter Pflaum, MD, Christian J. Strasburger, MD, Karl Josef Osterziel, MD^*, Wolfram Doehner, MD^* , Michael B. Ranke, MD^||, Philip A. Poole-Wilson, MD, FACC, Andrea Giustina, MD^¶, Rainer Dietz, MD^* and Andrew J. S. Coats, DM, FACC

^* Franz-Volhard-Klinik (Charité, Campus Berlin-Buch) at Max Delbrück Centrum for Molecular Medicine, Charité, Berlin, Germany
Clinical Cardiology, National Heart and Lung Institute, Imperial College School of Medicine, London, United Kingdom
Department of Cardiology, Salvatore Maugeri-Foundation, Gussago, Italy
Medizinische Klinik, Ludwigs Maximilian Universität Munich, Munich; Germany
^|| Sektion Pädiatrische Endokrinologie, Kinderklinik, Eberhardt-Karls-Universität, Tübingen, Germany
^¶ Endocrine Section, Department of Internal Medicine, University of Brescia, Brescia, Italy

View larger version (22K): [in a new window]   Figure 1 (A) Relationship between circulating growth hormone (GH) and insulin-like growth factor-I (IGF-I) levels (log IGF-I/GH ratio) in patients with chronic heart failure (CHF) and healthy control subjects. (B) Relationship between functionally intact GH-binding protein (BP) and the log IGF-I/GH ratio. Data are from study 1 and are presented as the mean value ± SD. *p < 0.0001; **p = 0.0001 vs. cachectic patients with CHF.

View larger version (24K): [in a new window]   Figure 2 Relationship between the log insulin-like growth factor-I/growth hormone (IGF-I/GH) ratio (from a single sample in the morning) and mean (A) and peak (B) GH levels in 8-h overnight blood samples (study 2). **p < 0.01 vs. control subjects. (C) Relationship between baseline GH-binding protein (BP) levels and the IGF-I response to GH (2 IU/day for 24 h) in nine patients with chronic heart failure (CHF) (study 2) (polynomial correlation: r = 0.90, p = 0.006).

View larger version (23K): [in a new window]   Figure 3 Relationship between growth hormone-binding protein (GH-BP) levels at baseline and biochemical (insulin-like growth factor-I [IGF-I]) response to GH (2 IU/day for 14 weeks) in 24 patients with chronic heart failure. Data are from study 3.