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CLINICAL STUDY |
Department of Medical Sciences, Internal Medicine, 1 Department of Public Health and Caring Sciences and 2 Department of Geriatrics and Surgery, Uppsala University Hospital, S-75185 Uppsala, Sweden
(Correspondence should be addressed to B Edén Engström; Email: britt.eden_engstrom{at}medsci.uu.se)
Objective: Overfeeding suppresses GH secretion and makes evaluation of a suspected GH deficiency (GHD) difficult. In normal weight subjects, gender is known to influence GH concentrations, which is most apparent in the ambulatory, morning-fasted state. In this study, we examined the GH/IGF-I axis in obese men and women and the effect of surgically induced weight loss.
Design: Sixty-three subjects (body mass index (BMI) 45 ± 6 kg/m2; 54 women, 9 men) were studied prior to, and 6 and 12 months following Roux-en-Y gastric bypass (RYGBP) surgery. Fifty-four patients with classic GHD (BMI 27 ± 6 kg/m2; 35 men, 19 women) were included for comparison. Methods: Hormones were analysed in fasting morning serum samples.
Results: RYGBP resulted in a decreased BMI to 35 ± kg/m2 at 6 months and 32 ± 6 kg/m2 at 12 months. GH and IGF-I increased at 6 months in the women and at 12 months in both sexes by
300 and 11% respectively. Prior to RYGBP, GH concentrations were low in the obese men and similar to those of GHD men (mean 0.09 mU/l). Obese women had tenfold higher values than obese men and sevenfold higher than GHD women. IGF-I levels were in the low reference range in the obese and below 2 S.D. for age in 13%.
Conclusions: Surgically induced weight loss partially restores GH secretion. Despite a marked suppression of GH values, a gender influence is maintained in severe obesity. In obese women, single morning GH and IGF-I values seem sufficient to exclude a suspicion of classic GHD.
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