Multiple hormone deficiencies in chronic heart failure.

Anabolic hormones are endowed with powerful actions on both the cardiovascular system and the skeletal muscle. In western countries, an age-related decline of anabolic hormones including IGF-1, testosterone and DHEA-S is extensively described, and thought to contribute to sarcopenia, visceral adiposity and osteopenia. This decline has been often referred to as somato- and andro-pause [4] and [5]. In the last decade, a growing body of evidence has led to the hypothesis that chronic heart failure (CHF) is indeed a multiple hormone deficiency syndrome (MHDS), characterized by a reduced anabolic drive that bears relevant functional and prognostic implications. Of note, Growth Hormone (GH) or testosterone replacement therapy provides beneficial effects, particularly on exercise tolerance and well-being. Despite the emerging role of the MHDS, very few studies have described its prevalence in mild-to-moderate CHF, particularly focusing on age-related trends, and none has described simultaneous deficiencies of somatotropic, thyroid, adrenal, and gonadal axes. Therefore, the purpose of the current study was to clarify the age-related prevalence of MHDS in patients with CHF. In an unselected population of 202 stable CHF patients, 107 male subjects with CHF, NYHA classes I–III, were enrolled in three tertiary referral centers. The inclusion criteria were: male sex, age > 18 years, stable medications for at least three months including ß-blocker, left ventricular ejection fraction (LVEF) of 40% or below, and signed informed consent. Patients undergoing an active hormone treatment, with known advanced kidney disease (eGRF < 30 mL/min) or liver cirrhosis were excluded. The patients recruited were studied after 3 months of optimized medical therapy and clinical stability. In conclusion, the high prevalence of HD in CHF patients particularly in younger patients, its association with poor survival, and the recent evidence of beneficial effects of hormonal replacement therapies in CHF, supports the role for a hormonal screening in these patients.