Alterations of haemostatic and fibrinolytic markers in adult patients with growth hormone deficiency and with acromegaly

Summary:

Alterations of coagulation and fibrinolytic systems might contribute to the increased cardiovascular and cerebrovascular mortality observed in patients with both chronic growth hormone (GH) excess (acromegaly) and deficiency (GHD). However, contrasting results have been so far reported. To assess the importance of GH in modulating haemostatic system, several haemostatic variables in patients with GHD and acromegaly were measured. Twenty-four adult patients with GHD (8 childhood- and 16 adult-onset; age: 41 ± 12 years, insulin like growth factor-I, IGF-I: 6.7 ± 4 nmol/L), 10 non-diabetic acromegalic patients (age: 39 ± 15 years; IGF-I: 109 ± 37 nmol/L) and 64 healthy volunteers age- and sex-matched with cases were studied. The plasma levels of tissue-type plasminogen activator antigen (t-PA), prothrombin fragment 1 + 2 (F1 + 2) and thrombin-antithrombin complex (TAT) were measured by ELISA. Plasminogen activator inhibitor type 1 (PAI-1) was measured by an immunoactivity assay and fibrinogen by von Clauss method. GH levels were measured by IFMA and IGF-I by RIA. GHD patients had higher PAI-1 (12.7 ± 16.7 vs 4.8 ± 5.3 U/ml, p < 0.01), fibrinogen (363 ± 104 vs 291 ± 71 mg/dL, p < 0.05) and TAT levels (6.8 ± 9 vs 3.6 ± 2.8 ng/ml, p < 0.05) than controls. Taking the 95th pecentile of the normal distribution in the control group as the cut-off point for normal plasma levels of the haemostatic variables, high PAI levels were found in 25% of patients with GHD (P < 0.01), while high fibrinogen and TAT levels were observed in 21% (P < 0.05). The alterations were mostly present in patients with adult-onset GHD, with the exception of hyperfibrinogenaemia which was equally present in adult- and childhood-onset patients. Acromegalic patients had higher mean fibrinogen levels than controls (398 ± 111 vs 291 ± 71 mg/dL, p < 0.05), 40% having hyperfibrinogenaemia (P < 0.01, vs controls). They also had t-PA levels lower than controls and GHD. No correlations between hormonal and haemostatic variables were found. Body mass index and waist to hip ratio correlated positively with PAI-1 levels in GHD patients only. In conclusion, this study shows that several abnormalities of coagulation variables (increased PAI-1, fibrinogen and TAT levels) are present in patients with GHD, while only hyperfibrinogenaemia is found in patients with acromegaly. These changes do not appear to be directly related to IGF-I levels or to the degree of GH deficiency/excess. However, these abnormalities may be an additional trigger for the development of coronary heart disease and thromboembolic complications mostly in patients with GHD.

Key words:

Acromegaly - growth hormone deficiency - fibrinogen - plasminogen activator inhibitor 1 and coagulation variables

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