Growth hormone (GH) is a major regulator of growth, somatic development and body composition. Sex steroids can act centrally by regulating GH secretion and peripherally modulating GH responsiveness. This review addresses data of potential clinical relevance on how sex steroids modulate GH secretion and action, aiming to increase the understanding of sex steroid/GH interactions and leading to improved management of patients. Sex steroids regulate GH secretion directly as well as indirectly through IGF-I modulation. Testosterone stimulates GH secretion centrally, an effect dependent on prior aromatization to oestrogen. Oestrogen stimulates GH secretion indirectly by reducing IGF-I feedback inhibition. Whether oestrogen stimulates GH secretion centrally in females is unresolved. Gonadal steroids modify the metabolic effects of GH. Testosterone amplifies GH stimulation of IGF-I, sodium retention, substrate metabolism and protein anabolism while exhibiting similar but independent actions of its own. Oestrogen attenuates GH action by inhibiting GH-regulated endocrine function of the liver. This is a concentration-dependent phenomenon that arises invariably from oral administration of therapeutic doses of oestrogen, an effect that can be avoided by using a parenteral route. This strong modulatory effect of gonadal steroids on GH responsiveness provides insights into the biological basis of sexual dimorphism in growth, development and body composition and practical information for the clinical endocrinologist. It calls for an appraisal of the diagnostic criteria for GH deficiency of GH stimulation tests, which currently are based on arbitrary cut-offs that do not take into account the shifting baseline from the changing gonadal steroid milieu. In the management of GH deficiency in the hypopituitary female, oestrogen should be administered by a nonoral route. In hypopituitary men, androgens should be replaced concurrently to maximize the benefits of GH. In the general population, the metabolic consequences of long-term treatment of women with oral oestrogen compounds, including selective oestrogen receptor modulators, are largely unknown and warrant study.

译文

:生长激素(GH)是生长,体细胞发育和身体成分的主要调节剂。性类固醇可以通过调节GH分泌并在外围调节GH反应性来发挥中心作用。这篇综述探讨了有关性类固醇如何调节GH分泌和作用的潜在临床相关性数据,旨在增进对性类固醇/ GH相互作用的了解并改善患者的管理。性类固醇直接或通过IGF-I调节间接调节GH的分泌。睾丸激素可集中刺激GH分泌,其作用取决于先前对雌激素的芳香化作用。雌激素通过减少IGF-1反馈抑制作用间接刺激GH分泌。雌激素是否能集中刺激女性的GH分泌尚无定论。性腺类固醇会改变GH的代谢作用。睾丸激素可放大IGF-1的GH刺激,钠保留,底物代谢和蛋白质合成代谢,同时表现出类似但独立的作用。雌激素通过抑制GH调节的肝脏内分泌功能来减弱GH的作用。这是一种浓度依赖性现象,总是由口服治疗剂量的雌激素引起,这种现象可以通过肠胃外途径避免。性腺类固醇对GH反应性的这种强大调节作用为临床内分泌学家提供了有关生长,发育和身体组成方面性二态性的生物学基础的见解,并为临床内分泌学家提供了实用信息。它要求评估GH刺激试验中GH缺乏的诊断标准,该诊断标准目前基于任意临界值,该临界值未考虑来自不断变化的性腺类固醇环境的基线变化。在垂体下垂体GH缺乏症的治疗中,应通过非口服途径给予雌激素。在垂体下垂的男性中,应同时更换雄激素以最大程度地增加GH的益处。在一般人群中,口服雌激素化合物(包括选择性雌激素受体调节剂)对妇女进行长期治疗的代谢后果在很大程度上尚不清楚,值得研究。

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