Perfil hepático nos indivíduos com deficiência isolada de GH

Abstract

Non-alcoholic fatty liver disease (NAFLD) is known to be associated with insulin resistance, atherosclerosis, and low serum IGF-I levels. We have described a cohort with isolated GH deficiency (IGHD) due to the c.57+1G→A mutation in the GHRH receptor gene with visceral obesity, but increased insulin sensitivity (IS), delayed atherosclerosis and normal longevity. We hypothesized that despite visceral obesity, NAFLD would be absent or mild due to the increased IS. The objective is to assess the prevalence and severity of NAFLD in IGHD. We studied 22 IGHD adults and 25 controls (CO) matched for age and gender. NAFLD was assessed by a comprehensive liver function panel and a hyper echogenic ultrasonographic pattern (HP) coded as 0=absent; 1=mild; 2=moderate; and 3=severe. Compared to CO, IGHD individual had lower IGF- I (p < 0.0001), higher total cholesterol (p=0.027), lower prothrombin time (p= 0.017), similar activated partial thromboplastin time and fibrinogen values. ALT values were similar in both groups, but AST was higher in IGHD subjects (p=0.013). However, more IGHD subjects (7/ 22) than CO (3/23) had ALT above the upper limit of normal (p=0.044).The HP score was higher in IGHD than CO (p=0.041), but severe NAFLD was not observed in any IGHD (or CO) individual. In conclusion, liver HP score is increased in lifetime untreated IGHD, but the increase in transaminases is mild, suggesting lack of advanced forms of NAFLD.