Patients with dilated cardiomyopathy show reduction of the somatotroph responsiveness to GHRH both alone and combined with arginine

Objective: Altered function of the GH/IGF-I axis in patients with dilated cardiomyopathy (DCM) has been reported. In fact, DCM patients show reduction of IGF-I levels, which could reflect slight peripheral GH resistance or, alternatively, reduced somatotroph secretion. Spontaneous GH secretion has been reported to be altered by some but not by other authors, whereas the GH response to GHRH, but not that to GH-releasing peptides, seems reduced in DCM patients. On the other hand, it is well known that the GH response to GHRH in humans is markedly potentiated by arginine (ARG), which probably acts via inhibition of hypothalamic somatostatin release; in fact the GHRH+ARG test is known as one of the most reliable to evaluate the maximal secretory capacity of somatotroph cells. Methods: In order to further clarify the somatotroph function in DCM, in well-nourished patients with DCM (34 male, 4 female; age (mean ± S.E.M.) 57.8 ± 1.1 years; body mass index (BMI) 24.6 ± 0.6 kg/m²; left ventricular ejection fraction 23.2 ± 1.6%; New York Heart Association classification I/1, II/17, III/18, IV/2) we studied the GH response to GHRH (1.0 μg/kg i.v.) alone or combined with ARG (0.5 g/kg i.v.). The results in DCM patients were compared with those in age- matched control subjects (CS) (39 male, 7 female; age 58.9 ± 1.0 years; BMI 23.2 ± 0.3 kg/m²). Results: Mean IGF-I levels in DCM patients were lower than in CS (144.3 ± 6.9 vs 175.1 ± 8.4 μg/l, P < 0.05) whereas basal GH levels were similar in both groups (1.7 ± 0.3 vs 1.7 ± 0.3 μg/l). The GH response to GHRH in DCM patients was lower (P < 0.05) than that in CS (GH peak 6.5 ± 1.2 vs 10.7 ± 2.1 μg/l). In both groups the GH response to GHRH + ARG was higher (P < 0.001) than that to GHRH alone. However, the GH response to GHRH + ARG in DCM patients remained clearly lower (P < 0.01) than that in CS (18.3 ± 3.2 vs 34.1 ± 4.6 μg/l). The GH response to GHRH alone and combined with ARG was not associated with the severity of the disease. Conclusion: DCM patients show blunted GH responses to GHRH both alone and combined with ARG. Evidence that ARG does not restore the GH response to GHRH in DCM patients makes it unlikely that the somatotroph hyporesponsiveness to the neurohormone reflects hyperactivity of hypothalamic somatostatinergic neurons.