Investigation of the Skin Characteristics in Patients with Severe GH Deficiency and the Effects of 6 Months of GH Replacement Therapy: A Randomized Placebo Controlled Study

Fatih Tanriverdi; Murat Borlu; Hulusi Atmaca; Cagdas Atasavun Koc; Kursad Unluhizarci; Serap Utas; Fahrettin Kelestimur

Disclosures

Clin Endocrinol. 2006;65(5):579-585. 

In This Article

Summary and Introduction

Summary

Objective: The presence of GH receptor in human skin and its appendages suggests a direct effect of GH on skin characteristics. The skin is usually thin and dry in patients with GH deficiency (GHD). Sheehan's syndrome classically refers to postpartum hypopituitarism and GH is one of the earliest pituitary hormones lost. While severe GHD is a well-established feature of Sheehan's Syndrome, skin characteristics and the effects of GH replacement therapy (GHRT) have been investigated neither in Sheehan's syndrome nor in other disorders of GHD. The aim of this study was to investigate the skin characteristics, including the sebum content, hydration (skin capacitance), transepidermal water loss (TEWL), pH and skin temperature, and particularly the effects of 6 months of GHRT on these parameters in GH deficient patients with Sheehan's syndrome.
Patients and design: Sixteen severely GH deficient women with Sheehan's syndrome (48·1 ± 10·9 years), and 20 age and menopausal status similar women as control subjects were included. Ten patients received recombinant GH for 6 months (treatment group) and 6 patients received placebo (placebo group) during this period. Skin properties were measured at baseline and after 6 months of GHRT using noninvasive and well-established measuring methods.
Results: At baseline the skin capacitance was significantly decreased on the forehead and forearm, and sebum content was significantly decreased on forehead in patients with Sheehan's syndrome compared to control subjects (P < 0·05). In the treatment group there was a significant increase in sebum content on forehead after 6 months of GHRT compared to the baseline value (P < 0·05). However there were no significant changes in other parameters including sebum content on the forearm, TEWL, Ph, skin capacitance and temperature of both the forearm and forehead. In the placebo group there were no changes in any of the evaluated parameters after 6 months of treatment compared to baseline values.
Conclusions: The present study clearly shows that the sebum content on the forehead and skin hydration of the forehead and forearm are significantly decreased in GH deficient patients with Sheehan's syndrome. However 6 months of GHRT significantly increased only the sebum content on the forehead. These data suggest that GH and/or IGF-I may have a modulatory role on several skin characteristics.

Introduction

Since Growth hormone deficiency (GHD) in adults has been accepted as a clinical entity[1] several effects of GHD have been studied extensively. GHD in adults is associated with abnormal body composition,[2,3] altered lipid profile with decreased high density lipoprotein (HDL) cholesterol and increased low density lipoprotein (LDL) cholesterol,[4,5] osteoporosis,[2,5] altered cardiac function including cardiac autonomic tone[6] and impaired cognitive function.[7] Improvements in most of these parameters have been demonstrated in previous studies.[2,5,6,7,8]

The presence of GH receptors in human skin and its appendages suggests a direct effect of GH on skin characteristics.[9,10] The skin is usually thin and dry in patients with GHD.[1,11,12] However, at least to our knowledge, there are not enough data regarding the effects of GH deficiency and the effects of GH replacement therapy (GHRT) on the skin. For this reason, we intended to investigate the relationship between GHD and skin changes, and we have demonstrated that hydration of the skin and sebum content were decreased in GH deficient patients.[13] We, therefore, decided to assess the effects of GHRT on skin changes in GH deficient patients with Sheehan's syndrome.

Sheehan's syndrome classically refers to postpartum hypopituitarism due to pituitary necrosis occurring during severe hypotension or shock secondary to massive bleeding.[14] It is still a serious health problem in some developing countries and is characterized by varying degrees of anterior pituitary dysfunction.[11] While severe GH deficiency is a well-established feature of Sheehan's Syndrome,[5,15] skin characteristics and the effects of GHRT have not been investigated neither in Sheehan's syndrome nor in other GH deficiency disorders.

The aim of this study was to investigate the skin characteristics, including the sebum content, hydration (skin capacitance), transepidermal water loss (TEWL), pH, skin temperature, and particularly the effects of 6 months of GHRT on these parameters in GH deficient patients with Sheehan's syndrome.

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