Background: Experimental data in human subjects demonstrate that growth hormone (GH) acutely inhibits glucose disposal in skeletal muscle. The insulin-antagonistic effects are clinically relevant since active acromegaly is accompanied by glucose intolerance, whereas children with GH deficiency may develop fasting hypoglycemia. At the same time, GH stimulates the turnover and oxidation of free fatty acids (FFAs), and there is experimental evidence to suggest a causal link between elevated FFA levels and insulin resistance in skeletal muscle. During fasting, the induction of insulin resistance by GH is associated with enhanced lipid oxidation and protein conservation, which seems to constitute a favorable metabolic adaptation. Conclusions: Observational data in GH-deficient adults do not indicate that GH replacement is associated with significant impairment of glucose tolerance; however, care should be taken to avoid overdosing and to monitor glycemic control.

1.
Houssay BA: The hypophysis and metabolism. N Engl J Med 1936;214:961–985.
2.
Rabinowitz D, Klassen GA, Zierler KL: Effects of human growth hormone on muscle and adipose tissue metabolism in the forearm of man. J Clin Invest 1965;44:51–61.
3.
Møller N, Schmitz O, Jørgensen JO, Astrup J, Bak JF, Christensen SE, Alberti KG, Weeke J: Basal- and insulin-stimulated substrate metabolism in patients with active acromegaly before and after adenomectomy. J Clin Endocrinol Metab 1992;74:1012–1019.
4.
Kopchick JJ, Parkinson C, Stevens EC, Trainer PJ: Growth hormone receptor antagonists: discovery, development, and use in patients with acromegaly. Endocr Rev 2002;23:623–646.
5.
Jørgensen JO, Feldt-Rasmussen U, Frystyk J, Chen JW, Kristensen LO, Hagen C, Orskov H: Cotreatment of acromegaly with a somatostatin analog and a growth hormone receptor antagonist. J Clin Endocrinol Metab 2005;90:5627–5631.
6.
Jørgensen JOL, Møller J, Alberti KGMM, Schmitz O, Christiansen JS, Møller N: Marked effects of sustained low growth hormone (GH) levels on day-to-day fuel metabolism: studies in GH deficient patients and healthy untreated subjects. J Clin Endocrinol Metab 1993;77:1589–1596.
7.
Nørrelund H, Vahl N, Juul A, Møller N, Alberti KGMM, Skakkebæk NE, Christiansen JS, Jørgensen JOL: Continuation of growth hormone (GH) therapy in GH-deficient patients during transition from childhood to adulthood: impact on insulin sensitivity and substrate metabolism. J Clin Endocrinol Metab 2000;85:1912–1917.
8.
Nørrelund H: The metabolic role of growth hormone in humans with particular reference to fasting. Growth Horm IGF Res 2005;15:95–122.
9.
Shulman GI: Cellular mechanisms of insulin resistance. J Clin Invest 2000;106:171–176.
10.
Nielsen S, Møller N, Christiansen JS, Jørgensen JO: Pharmacological antilipolysis restores insulin sensitivity during growth hormone exposure. Diabetes 2001;50:2301– 2308.
11.
Jessen N, Djurhuus CB, Jørgensen JO, Jensen LS, Møller N, Lund S, Schmitz O: Evidence against a role for insulin-signaling proteins PI 3-kinase and Akt in insulin resistance in human skeletal muscle induced by short-term GH infusion. Am J Physiol Endocrinol Metab 2005;288:E194–E199.
12.
Jørgensen JOL: Human growth hormone replacement therapy: pharmacological and clinical aspects. Endocr Rev 1991;12:189–207.
13.
Gotherstrom G, Svensson J, Koranyi J, Alpsten M, Bosaeus I, Bengtsson B, Johannsson G: A prospective study of 5 years of GH replacement therapy in GH-deficient adults: sustained effects on body composition, bone mass, and metabolic indices. J Clin Endocrinol Metab 2001;86:4657–4665.
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