Use of growth hormone and other anabolic agents in AIDS wasting

JPEN J Parenter Enteral Nutr. 1999 Nov-Dec;23(6 Suppl):S202-9.

Use of growth hormone and other anabolic agents in AIDS wasting.

Mulligan K, Tai VW, Schambelan M.

Division of Endocrinology, San Francisco General Hospital, CA 94110, USA.

Body wasting and loss of lean body mass (LBM) have been associated with increased
mortality and disease progression, and reduced quality of life, in patients with
human immunodeficiency virus (HIV) infection. The failure of nutritional
therapies and, more recently, of effective viral suppression, to consistently
restore LBM has prompted investigation of the pharmacologic use of a number of
specific protein anabolic agents, including recombinant human growth hormone
(rhGH), insulin-like growth factor I (rhIGF-I), and synthetic testosterone
derivatives, such as nandrolone decanoate, oxandrolone, and oxymetholone. In a
placebo-controlled trial, treatment with rhGH resulted in a significant and
sustained increase in weight that was accompanied by an even greater increase in
LBM and a decrease in fat, and improvement in treadmill work output. Preliminary
data suggest that short-term rhGH treatment may be effective in mitigating weight
loss in patients with secondary infections. Open-label studies of nandrolone
decanoate suggest that this injectable agent also can increase weight and LBM.
Two oral agents, oxandrolone and oxymetholone, can increase weight, but their
effects on LBM in placebo-controlled trials have not been reported. Taken
together, these studies demonstrate that HIV-infected individuals can regain
weight and LBM under the proper therapeutic circumstances. The effects of
reversal of wasting on survival and disease progression, long-term safety, and
the potential value of these therapies in the treatment of fat redistribution
remain to be determined.

Anabolic steroid and gonadotropin releasing hormone analog combined treatment increased pubertal height gain and adult height in two children who entered puberty with short stature.

J Pediatr Endocrinol Metab. 2006 Sep;19(9):1125-31.

Anabolic steroid and gonadotropin releasing hormone analog combined treatment
increased pubertal height gain and adult height in two children who entered
puberty with short stature.

Satoh M, Yokoya S.

First Department of Pediatrics, Toho University School of Medicine, Japan.
satomari@med.toho-u.ac.jp

We studied the effect of gonadal suppression treatment in combination with
anabolic steroid on pubertal height gain and adult height in two children who
entered puberty with short stature. Patient 1 was a female with idiopathic short
stature. She received combined treatment with an anabolic steroid (stanozolol)
and a gonadotropin releasing hormone analog (leuprorelin acetate). Her pubertal
height gain was 28.5 cm, which is greater than that in normal height girls (20-25
cm). Patient 2 was a male with Aarskog syndrome. Although his growth hormone (GH)
secretion was normal, he received GH treatment. Since GH administration did not
accelerate his growth, he received combined treatment with stanozolol and
leuprorelin acetate. His pubertal height gain was 27.0 cm, which is greater than
that observed in GH deficient boys treated with GH alone (21.9 cm). Combined
treatment with stanozolol and leuprorelin acetate appears to be effective in
increasing pubertal height gain and adult height in children who enter puberty
with short stature.

Growth-promoting effect of recombinant human growth hormone and stanozolol in girls with Turner syndrome.

J Tongji Med Univ. 1999;19(1):63-5.

Growth-promoting effect of recombinant human growth hormone and stanozolol in
girls with Turner syndrome.

Fang J, Ning C, Shu D, Wei H, Lin H, Wang M.

Department of Pediatrics, Tongji Hospital, Tongji Medical University, Wuhan
430030.

Ten girls with Turner syndrome were treated with a combination therapy of
recombinant human growth hormone (R-hGH) and low dose stanozolol for a period of
8 to 36 months. The results showed that when compared with the growth rate before
the treatment, the growth rates after treatment with R-hGH and stanozolol showed
a sustained increase, reaching 9.0 +/- 1.9 cm/year during the first year of
treatment; the height age increase by 2.5 +/- 0.8 years while the bone age
increase were 1.0 +/- 0.7 years; and the predicted final adult height at the end
of the first year of the treatment increased to 149.4 +/- 6.1 cm compared to
their original mean of 142.8 +/- 4.2 cm. We are led to conclude that therapy with
R-hGH in combination with stanozolol can increase the growth velocity and
significantly increase the predicted adult height of children with Turner
syndrome.

Short-term modulation of the androgen milieu alters pulsatile, but not exercise- or growth hormone (GH)-releasing hormone-stimulated GH secretion in healthy men: impact of gonadal steroid and GH secretory changes on metabolic outcomes.

J Clin Endocrinol Metab. 1997 Nov;82(11):3710-9.

Short-term modulation of the androgen milieu alters pulsatile, but not exercise-
or growth hormone (GH)-releasing hormone-stimulated GH secretion in healthy men:
impact of gonadal steroid and GH secretory changes on metabolic outcomes.

Fryburg DA, Weltman A, Jahn LA, Weltman JY, Samojlik E, Hintz RL, Veldhuis JD.

Department of Internal Medicine, General Clinical Research Center,
Charlottesville, Virginia, USA. david_a_fryburg@groton.pfizer.com

Gonadal steroids are known to alter GH secretion as well as tissue metabolism.
The present study was designed to examine the effects of short term (2- to
3-week) alterations in gonadal steroids on basal pulsatile (nonstimulated) and
exercise- and GH-releasing hormone-stimulated GH secretion, urinary nitrogen
excretion, and basal and exercise-stimulated oxygen consumption. Two protocols
were conducted, which reflect a total of 18 separate studies. In the first
paradigm, 5 healthy young men were each studied in a double blind, randomized
manner during 3 different gonadal hormone manipulations, in which serum
testosterone was varied from hypogonadal (induced by leuprolide) to eugonadal
(saline injections) to high levels (testosterone enanthate, 3 mg/kg.week, i.m.).
There was a washout period of 8 weeks between treatments. In the second protocol,
3 of the original subjects were studied after 2 weeks of treatment with
stanozolol (0.1 mg/kg.day). Two to 3 weeks after the desired changes in serum
testosterone, each subject was admitted to the General Clinical Research Center
for study. The hypogonadal state (serum testosterone, 33 ng/dL) increased urinary
nitrogen loss (by 34%; P < 0.005) and decreased basal metabolic rate (by 12%; P <
0.02) compared with the eugonadal state (testosterone, 796 ng/dL). High dose
testosterone (1609 ng/dL) further decreased urinary nitrogen loss over the
eugonadal state (by 16%; P < 0.05). Stanozolol yielded the lowest urinary
nitrogen excretion of all (P < 0.03). Like urinary nitrogen, the basal metabolic
rate showed the greatest change between the hypogonadal and eugonadal states
(12%; P < 0.02), with a lesser change during high dose testosterone treatment
(4%). Analogously, end-exercise oxygen consumption rose by 11% between the
hypogonadal and eugonadal states (P < 0.05). Between the hypogonadal and
eugonadal states, no significant changes in pulsatile (nonstimulated),
exercise-stimulated, or GRF-stimulated GH secretion or serum insulin-like growth
factor I concentrations were observed. Raising testosterone to supraphysiological
levels increased pulsatile GH secretion by 62% over that with leuprolide and by
22% over that with saline (P < 0.05). High dose testosterone treatment also
increased serum insulin-like growth factor I concentrations by 21% and 34% over
those during the eugonadal and hypogonadal states, respectively (P < 0.01).
Testosterone did not affect either exercise- or GRF-stimulated GH secretion. In
protocol 2, stanozolol did not affect any parameter of GH secretion. To examine
the interaction between GH secretion and testosterone on urinary nitrogen
excretion and basal metabolic rate, a one-way analysis of covariance was
undertaken. Statistical examination of GH production as the covariate and
testosterone (by tertile) as the interactive factor demonstrated significant
relationships between serum testosterone levels and either urinary nitrogen (P <
0.02) or basal metabolic rate (P < 0.01), but not GH secretion (P = NS). In
summary, these results demonstrate that short term modulation of the androgen
milieu affects metabolic outcome without necessitating changes in GH secretion.
These results have significance for both normal physiology and for the treatment
of hypogonadal GH-deficient patients.

Anabolic steroid and gonadotropin releasing hormone analog combined treatment increased pubertal height gain and adult height in two children who entered puberty with short stature.

Satoh M, Yokoya S.

Anabolic steroid and gonadotropin releasing hormone analog combined treatment increased pubertal height gain and adult height in two children who entered puberty with short stature.

J Pediatr Endocrinol Metab. 2006 Sep;19(9):1125-31

ABSTRACT: We studied the effect of gonadal suppression treatment in combination with anabolic steroid on pubertal height gain and adult height in two children who entered puberty with short stature. Patient 1 was a female with idiopathic short stature. She received combined treatment with an anabolic steroid (stanozolol) and a gonadotropin releasing hormone analog (leuprorelin acetate). Her pubertal height gain was 28.5 cm, which is greater than that in normal height girls (20-25 cm). Patient 2 was a male with Aarskog syndrome. Although his growth hormone (GH) secretion was normal, he received GH treatment. Since GH administration did not accelerate his growth, he received combined treatment with stanozolol and leuprorelin acetate. His pubertal height gain was 27.0 cm, which is greater than that observed in GH deficient boys treated with GH alone (21.9 cm). Combined treatment with stanozolol and leuprorelin acetate appears to be effective in increasing pubertal height gain and adult height in children who enter puberty with short stature.