Metabolic Syndrome

This metabolic disorder—called Syndrome X Metabolic Syndrome (Hyperinsulinemia)—is estimated to affect about 47 million U.S. adults and, in many cases, goes unrecognized. Traditional therapies are not as effective as those having a balanced endocrine component. The good news is that once diagnosis and a complete metabolic and endocrine evaluation is accomplished, appropriate therapies can markedly improve or completely eliminate the signs and symptoms of Syndrome X, as well as the serious negative health consequences associated with it.

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Definitions from the American Heart Association and the official definition from the National Heart, Lung, and Blood Institute (NHLBI) . . . 

American Heart Association 
National Heart, Lung, and Blood Institute (NHLBI) 
Syndrome X (Hyperinsulinemia) by Eileen M. Wright, MD

Aging, Adiposity, and Calorie Restriction.pdf

This study concluded that calorie restriction in adult men and women causes beneficial metabolic, hormonal, and functional changes, but the precise amount of calorie intake or body fat mass associated with optimal health and maximum longevity in humans is not known. In addition, it is possible that even moderate calorie restriction may be harmful in specific patient populations, such as lean persons who have minimal amounts of body fat.
Fontana, L. & Klein, S. (2007). Aging, adiposity, and calorie restriction [Electronic version]. The Journal of the American Medical Association, 297(9), 986-994. Retrieved May 2, 2007.

Therapeutic Aspects of Growth Hormone and Insulin-Like Growth Factor-I Treatment on Visceral Fat and Insulin Sensitivity in Adults.pfd

According to the authors, they have found that a very low dose GH therapy (0.1 mg/day) improved insulin sensitivity without affecting body composition in GH-deficient adults and in subjects with metabolic syndrome, and they postulate that these effects are mediated by its ability to increase free 'bioavailable' IGF-I without the induction of lipolysis. These results raise the possibility that this low GH dose may play a role in preventing the decline of beta-cell function and the development of type 2 diabetes in these "high risk" subjects.
Yuen, K.C. & Dunger, D.B. (2007). Therapeutic aspects of growth hormone and insulin-like growth factor-I treatment on visceral fat and insulin sensitivity in adults [Electronic version]. Diabetes, Obesity & Metabolism, 9(1), 11-22. Retrieved May 14, 2007.

Low SHBG, Testosterone, and Clinical AD Are Linked to Metabolic Syndrome Development.pdf

According to this article, low sex hormone-binding globulin, total testosterone, and symptomatic androgen deficiency are associated with development of the metabolic syndrome in nonobese men.
(2006, April 27). Low SHBG, testosterone, and clinical AD are linked to metabolic syndrome development [Electronic version]. NewsRx.com. Retrieved November 14, 2006.

What’s in a Name? Reflections on the (Suddenly) Controversial ‘Metabolic Syndrome’.pdf

According to this article, for many of us, it’s easier to think about multiple problems as having one root cause, or at least a common underlying complex pathophysiology. Hypertension, dysglycemia, dyslipidemia, and central obesity occur in the same patients more often than by chance alone.
Brieztke, S. (2006, March). What’s in a name? Reflections on the (suddenly) controversial ‘metabolic syndrome’ [Electronic version]. Endocrine Today, 4(3), 4-5. Retrieved November 16, 2006.

Does Growth Hormone Cause Cancer?.pdf

This study concluded that even if GH/IGF-1 therapy does result in a small increase in cancer risk compared to untreated patients with GH deficiency, it is likely that the eventual risk will be the same as the general population. Such a restoration to normality will need to be balanced against the known morbidity of untreated GH deficiency.
Jenkins, P.J., Mukherjee, A. & Shalet, S.M. (2006). Does growth hormone cause cancer? [Electronic version]. Clinical Endocrinology (Oxford), 64(2), 115-121. Retrieved November 14, 2006.

The Age Related Decrease in Testosterone is Significantly Exacerbated in Obese Men with the Metabolic Syndrome. What are the Implications for the Relatively High Incidence of Erectile Dysfunction Observed in These Men?.pdf

This study demonstrated that aging men with obesity and the metabolic syndrome have a significant decrease in total serum testosterone levels compared to aging, metabolically healthy men. These data suggest that the well established association between erectile dysfunction and pre-diabetes/diabetes (particularly in obese pre-diabetic/diabetic patients) may involve a hormonal component.
Kaplan, S.A., Meehan, A.G. & Shah, A. (2006). The age related decrease in testosterone is significantly exacerbated in obese men with the metabolic syndrome. What are the implications for the relatively high incidence of erectile dysfunction observed in these men? [Electronic version]. The Journal of Urology, 176(4 Pt. 1), 1524-1527, discussion 1527-1528. Retrieved November 27, 2006.

Hormone Profiles After Intramuscular Injection of Testosterone Enanthate in Patients with Hypogonadism.pdf

To examine hormone levels after androgen replacement therapy (ART) in Japanese male patients with hypogonadism, nine Japanese male patients with hypogonadism (serum total testosterone (tT) or free testosterone (fT) levels of < or = 2.7 ng/mL or < or = 10 pg/mL, respectively; average age, 59 years) were enrolled.
Nakazawa, R., Baba, K., Nakano, M., Katabami, T., Saito, N., Takahashi, T., et al. (2006). Hormone profiles after intramuscular injection of testosterone enanthate in patients with hypogonadism  [Electronic version]. Endocrine Journal, 53(3), 305-310. Epub May 19, 2006. Retrieved November 27, 2006.

Growth Hormone Treatment Reduces Abdominal Visceral Fat in Postmenopausal Women with Abdominal Obesity: A 12-Month Placebo-Controlled Trial.pdf

This study concluded that in postmenopausal women with abdominal obesity, 1 yr of GH treatment improved insulin sensitivity and reduced abdominal visceral fat and total and low-density lipoprotein cholesterol concentrations. The improvement in insulin sensitivity was associated with reduced hepatic fat content.
Franco, C., Brandberg, J., Lonn, L., Andersson, B., Bengtsson, B.A. & Johannsson, G. (2005). Growth hormone treatment reduces abdominal visceral fat in postmenopausal women with abdominal obesity: a 12-month placebo-controlled trial [Electronic version]. The Journal of Clinical Endocrinology and Metabolism, 90(3), 1466-1474. Epub 2004, December 14. Retrieved November 9, 2005.

Abdominal Obesity a Better Marker of Insulin Resistance Syndrome. Insulin Resistance Syndrome Increases Risk for Metabolic Syndrome, Type 2 Diabetes, CVD and PCOS.pdf

According to Mary Ann Banerji, MD, associate professor of medicine and endocrinology at SUNY Downstate Medical Center in Brooklyn, N.Y., abdominal obesity may be a better marker of insulin resistance syndrome than other indicators such as BMI and weight.  Banerji spoke about obesity and its association with insulin resistance syndrome at the 65^th Scientific Sessions of the American Diabetes Association.
Lewis, J. (2005). Abdominal obesity a better marker of insulin resistance syndrome. Insulin resistance syndrome increases risk for metabolic syndrome, type 2 diabetes, CVD and PCOS [Electronic version]. Endocrine Today, 3(8), 14.  (PDF)

Endogenous Sex Hormones and Metabolic Syndrome in Aging Men.pdf

This study concluded that higher testosterone and SHBG levels in aging males are independently associated with a higher insulin sensitivity and a reduced risk of the metabolic syndrome, independent of insulin levels and body composition measurements, suggesting that these hormones may protect against the development of metabolic syndrome.
Muller, M., Grobbee, D.E., den Tonkelaar, I., Lamberts, S.W. & van der Schouw, Y.T. (2005). Endogenous sex hormones and metabolic syndrome in aging men [Electronic version]. The Journal of Clinical Endocrinology and Metabolism, 90(5), 2618-2623. Epub 2005, February 1. Retrieved September 19, 2005.

Adults with Partial Growth Hormone Deficiency Have an Adverse Body Composition.pdf

In summary, this study has shown that adults with Growth Hormone Insufficiency (GHI) have abnormalities of body composition characteristic of Growth Hormone Deficiency (GHD). The degree of abnormality of body composition lies between that of healthy subjects and GHD adults and correlates with the IGF-I level. Any future trials of GH replacement in patients with GHI must await further studies to establish the exact impact of this relative deficiency on the broad spectrum of biological end points influenced by GH status.
Murray, R.D., Adams, J.E. & Shalet, S.M. (2004). Adults with partial Growth Hormone deficiency have an adverse body composition [Electronic version]. The Journal of Clinical Endocrinology and Metabolism, 89(4), 1586-1591. Retrieved November 21, 2005.

Risks of Testosterone-Replacement Therapy and Recommendations for Monitoring.pdf

According to this study, hypogonadism affects an estimated 2 million to 4 million men in the United States; its prevalence increases with age. However, it has been estimated that only 5 percent of affected men currently receive treatment. Recent interest in testosterone therapy has been fueled not only by increased medical awareness of the effects of hypogonadism, but also by media attention regarding hormone-replacement therapy in both men and women, the marketing of new topical testosterone formulations, and the desire of "baby boomers" to maintain vigor and health into their more mature years.
Rhoden, E.L. & Morgentaler, A. (2004). Risks of testosterone-replacement therapy and recommendations for monitoring [Electronic version]. The New England Journal of Medicine, 350(5), 482-492. Retrieved September 27, 2005.

Effects of Testosterone Administration on Fat Distribution, Insulin Sensitivity, and Atherosclerosis Progression.pdf

According to this article, testosterone infusion increases coronary blood flow. Similarly, testosterone replacement retards atherogenesis in experimental models of atherosclerosis. However, the long-term risks and benefits of testosterone administration in human immunodeficiency virus-infected men with fat redistribution syndrome have not been studied in randomized clinical trials.
Bhasin, S. (2003). Effects of testosterone administration on fat distribution, insulin sensitivity, and atherosclerosis progression [Electronic version]. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America, 37(Suppl. 2), S142-9. Retrieved September 27, 2005.

Growth Hormone Therapy in Adults.pdf

According to this review, Growth hormone (GH) is classically linked with linear growth in childhood but continues to have important metabolic actions throughout life. GH deficiency in adulthood causes a distinct syndrome with significant morbidities. These include increased total and visceral fat, decreased muscle mass and aerobic capacity, affective disturbances, abnormal lipids, and increased vascular mortality, all of which are ameliorated with GH replacement.
Cummings, D.E. & Merriam, G.R. (2003). Growth hormone therapy in adults [Electronic version]. Annual Review of Medicine, 54, 513-533. Retrieved December 7, 2005.

Insulin Resistance and Prostate Cancer Risk.pdf

In this study, the associations between prostate cancer risk and insulin sensitivity or resistance were independent of total caloric intake and serum levels of insulin-like growth factors, sex hormones, and sex hormone-binding globulin. Because of the retrospective design of this study, the role of insulin resistance in prostate cancer needs to be confirmed in prospective studies.
Hsing, A.W., Gao, Y.T., Chua, S., Jr., Deng, J. & Stanczyk, F.Z. (2003). Insulin resistance and prostate cancer risk [Electronic version]. Journal of the National Cancer Institute, 95(1), 67-71. Retrieved September 27, 2005.

Dehydroepiandrosterone Replacement in Healthy Men with Age-Related Decline of DHEA-S: Effects on Fat Distribution, Insulin Sensitivity and Lipid Metabolism.pdf

The results of this study did not reveal any significant changes in study parameters, apart from a statistically significant increase in DHEA-S levels after therapy with active substance.
Jedrzejuk, D., Medras, M., Milewicz, A. & Demissie, M. (2003). Dehydroepiandrosterone replacement in healthy men with age-related decline of DHEA-S: effects on fat distribution, insulin sensitivity and lipid metabolism [Electronic version]. The Aging Male, 6(3), 151-156. Retrieved December 7, 2005.
 

Hormone Replacement Therapy, Insulin Sensitivity, and Abdominal Obesity in Postmenopausal Women.pdf

The authors concluded that postmenopausal women taking oral estrogen or those taking a combination of estrogen and HRT are more insulin-resistant than women not on HRT, even when women are of comparable total and abdominal adiposity.
Ryan, A.S., Nicklas, B.J. & Berman, D.M. (2002). Hormone replacement therapy, insulin sensitivity, and abdominal obesity in postmenopausal women [Electronic version]. Diabetes Care, 25(1), 127-133. Retrieved January 19, 2006.