The sweating apparatus in growth hormone deficiency, following treatment with r-hGH and in acromegaly

• Published in: Autonomic neuroscience Vol. 89; no. 1; pp. 100 - 109
• Main Authors: Hasan, Wohaib, Cowen, Timothy, Barnett, Philip S, Elliot, Emma, Coskeran, Patsy, Bouloux, Pierre-M.G
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier B.V 20.06.2001; Elsevier
• Subjects: Acetylcholinesterase - analysis; Acromegaly; Acromegaly - pathology; Acromegaly - physiopathology; Adult; Adult growth hormone deficiency; Antigens, Differentiation - analysis; Autonomic nerves; Biological and medical sciences; Biopsy; Endocrinopathies; Female; Growth Disorders - drug therapy; Growth Disorders - pathology; Growth Disorders - physiopathology; Growth hormone; Growth Hormone - administration & dosage; Human Growth Hormone - deficiency; Humans; Hypothalamus. Hypophysis. Epiphysis (diseases); In Vitro Techniques; Insulin-like growth factor; Insulin-Like Growth Factor I - metabolism; Iontophoresis; Male; Medical sciences; Middle Aged; Muscarinic Agonists - pharmacology; Neuronal plasticity; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Pilocarpine - pharmacology; Sweat gland innervation; Sweat Glands - innervation; Sweat Glands - pathology; Sweat Glands - physiology; Sweating; Sweating - physiology; Sympathetic nerves; Sympathetic Nervous System - chemistry; Sympathetic Nervous System - enzymology; Sympathetic Nervous System - physiopathology; Thyroxine - blood; Triiodothyronine - blood; Tyrosine 3-Monooxygenase - analysis; Ubiquitin Thiolesterase; Vasoactive Intestinal Peptide - analysis; Vasoactive intestinal polypeptide; Adult growth hormone deficiency; Sweating; Sweat gland innervation; Neuronal plasticity; Vasoactive intestinal polypeptide; Acromegaly; Sympathetic nerves; Autonomic nerves; Growth hormone; Insulin-like growth factor; Endocrinopathy; Human; Sweat gland; Deficiency; Diseases of the osteoarticular system; Somatotropin hormone; Sympathetic nervous system; Chemotherapy; Treatment; Adenohypophyseal hormone; Autonomic nervous system; Pituitary diseases; Synaptic plasticity
• ISSN: 1566-0702; 1872-7484
• DOI: 10.1016/S1566-0702(01)00257-0

Adult growth hormone deficient patients are known to exhibit reduced sweating and their ability to thermoregulate is diminished. Treatment of these patients with recombinant human growth hormone (r-hGH) is claimed to reverse these abnormalities. We have investigated this claim, as well as the mechanism underlying these altered sweating responses in GH-deficient patients as part of a placebo-controlled study on the effects of 6–12 months r-hGH therapy. Skin biopsies were obtained from these subjects and changes in morphology and innervation parameters for the eccrine sweat glands were examined. These included histochemistry for acetylcholinesterase (AChE) and immunohistochemistry for the neuropeptide vasoactive intestinal polypeptide (VIP) and for PGP9.5, a general neuronal marker. Sweat gland acinar size and periacinar innervation were measured by computerised image analysis. The patients underwent pilocarpine iontophoresis sweat rate tests and their serum insulin-like growth factor 1 (IGF-1) levels were assessed. Since active acromegaly involves excess GH secretion and hyperhidrosis, skin biopsies and sweat tests were also carried out on a group of these patients, as well as on control subjects. We have demonstrated a sweating defect in adult GH-deficiency which is accompanied by a reduction in AChE and VIP levels in the nerve supply to sweat glands. Following r-hGH therapy, an increase in AChE and VIP staining is seen in the sudomotor nerves accompanied by restoration of sweat rates and serum IGF-1 levels. Hence, normalization of sweat gland function includes recovery of sudomotor synapse constituents. A trophic effect of GH on sweat gland epithelium and/or on the associated nerves is proposed, supported by the observation that in acromegaly the size of sweat gland acini and the density of innervation to the sweat glands was greater than in controls.