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Mark R Postma Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

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Pia Burman Department of Endocrinology, Skane University Hospital Malmö, University of Lund, Lund, Sweden

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André P van Beek Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

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capacity, bone health, several cardiovascular risk factors and quality of life ( 3 , 4 , 5 ). Pitfalls of GH and IGF-I assays and the recent upward adjustment of the normative IGF-I SD scores for the iSYS IGF-I assay make early recognition of AGHD

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Alessandro Ciresi Section of Endocrinology, Biomedical Department of Internal and Specialist Medicine (DIBIMIS), University of Palermo, Palermo, Italy

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Stefano Radellini Section of Endocrinology, Biomedical Department of Internal and Specialist Medicine (DIBIMIS), University of Palermo, Palermo, Italy

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Valentina Guarnotta Section of Endocrinology, Biomedical Department of Internal and Specialist Medicine (DIBIMIS), University of Palermo, Palermo, Italy

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Maria Grazia Mineo Section of Endocrinology, Biomedical Department of Internal and Specialist Medicine (DIBIMIS), University of Palermo, Palermo, Italy

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Carla Giordano Section of Endocrinology, Biomedical Department of Internal and Specialist Medicine (DIBIMIS), University of Palermo, Palermo, Italy

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one of the most influential regulators of growth hormone (GH) secretion and action, with different mechanisms ( 2 ). Androgens and estrogens exert opposite endocrine-mediated effects on insulin-like growth factor (IGF)-I production and metabolic

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Elena V Varlamov Department of Medicine (Endocrinology, Diabetes and Clinical Nutrition), Oregon Health & Science University, Portland, Oregon, USA
Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA
Pituitary Center, Oregon Health & Science University, Portland, Oregon, USA

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Dan Alexandru Niculescu Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA

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Swechya Banskota Department of Medicine (Endocrinology, Diabetes and Clinical Nutrition), Oregon Health & Science University, Portland, Oregon, USA
Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA
Pituitary Center, Oregon Health & Science University, Portland, Oregon, USA

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Simona Andreea Galoiu Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA

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Catalina Poiana Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA

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Maria Fleseriu Department of Medicine (Endocrinology, Diabetes and Clinical Nutrition), Oregon Health & Science University, Portland, Oregon, USA
Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA
Pituitary Center, Oregon Health & Science University, Portland, Oregon, USA

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comorbidities related to the tumor itself (e.g. headache, oculomotor never palsy or hypopituitarism) or to GH and insulin-like growth factor-1 (IGF-1) excess (arthralgia, morphologic changes, or obstructive sleep apnea (OSA), cardiovascular disease, and

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Juliane Léger Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Service d’Endocrinologie Diabétologie Pédiatrique, Centre de Référence des Maladies Endocriniennes de la Croissance et du développement, Paris, France
Université Paris Diderot, Sorbonne Paris Cité, Paris, France
Institut National de la Santé et de la Recherche Médicale (INSERM), Unité 1141, DHU PROTECT, Paris, France

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Anne Fjellestad-Paulsen Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Service d’Endocrinologie Diabétologie Pédiatrique, Centre de Référence des Maladies Endocriniennes de la Croissance et du développement, Paris, France

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Anne Bargiacchi Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Service de Psychiatrie de l’Enfant et de l’Adolescent, Centre de Référence des Maladies Endocriniennes de la Croissance et du développement, Paris, France

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Catherine Doyen Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Service de Psychiatrie de l’Enfant et de l’Adolescent, Centre de Référence des Maladies Endocriniennes de la Croissance et du développement, Paris, France

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Emmanuel Ecosse Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Service d’Endocrinologie Diabétologie Pédiatrique, Centre de Référence des Maladies Endocriniennes de la Croissance et du développement, Paris, France

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Jean-Claude Carel Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Service d’Endocrinologie Diabétologie Pédiatrique, Centre de Référence des Maladies Endocriniennes de la Croissance et du développement, Paris, France
Université Paris Diderot, Sorbonne Paris Cité, Paris, France
Institut National de la Santé et de la Recherche Médicale (INSERM), Unité 1141, DHU PROTECT, Paris, France

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Marie-France Le Heuzey Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Service de Psychiatrie de l’Enfant et de l’Adolescent, Centre de Référence des Maladies Endocriniennes de la Croissance et du développement, Paris, France

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involving the growth hormone (GH)-insulin-like growth factor-I (IGF-I) axis, thyroid function, hypercortisolemia, hypogonadotropic hypogonadism and the levels of several adipokines and gut peptides, such as ghrelin and peptide YY ( 2 ). The

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Melissa Braga Department of Internal Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California, USA

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Zena Simmons Department of Health & Life Sciences, Charles R. Drew University of Medicine and Science, Los Angeles, California, USA

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Keith C Norris Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA

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Monica G Ferrini Department of Internal Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California, USA
Department of Health & Life Sciences, Charles R. Drew University of Medicine and Science, Los Angeles, California, USA
Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA

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Jorge N Artaza Department of Internal Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California, USA
Department of Health & Life Sciences, Charles R. Drew University of Medicine and Science, Los Angeles, California, USA
Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA

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as ( 1 ) MYOD, ( 2 ) MYOG, ( 3 ) MYC type II, ( 4 ) muscle troponin I and troponin T, ( 5 ) MYH1 (myosin heavy chain I); and growth factors such as ( 6 ) IGF1 and 2, ( 7 ) FGF1 and 2, ( 8 ) BMP4 and ( 9 ) MMP9. Furthermore, exposure of satellite cells

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María Dolores Rodríguez Arnao Pediatric Endocrinology Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain

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Amparo Rodríguez Sánchez Pediatric Endocrinology Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain

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Ignacio Díez López Hospital Universitario Araba, Araba/Alava, Spain

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Joaquín Ramírez Fernández Hospital Universitario Príncipe de Asturias, Oviedo, Spain

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Jose Antonio Bermúdez de la Vega Centro Nuevas Tecnologias, Sevilla, Spain

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Diego Yeste Fernández Hospital Vall d’Hebrón, Barcelona, Spain

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María Chueca Guindulain Complejo Hospitalario de Navarra, Pamplona, Spain

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Raquel Corripio Collado Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain

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Jacobo Pérez Sánchez Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain

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Ana Fernández González Merck S.L.U., Madrid, Spain

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ECOS Spain Study Collaborative Investigator Group
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of the impact of insulin-like growth factor I (IGF-I) levels on adherence over the follow-up period. Demographic, auxological and diagnostic data were obtained from medical charts. All data were collected both retrospectively and prospectively. In

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Laurent Maïmoun Département de Médecine Nucléaire, Hôpital Lapeyronie, Centre Hospitalier Régional Universitaire (CHU) Montpellier, Montpellier, France
PhyMedExp, Université de Montpellier, INSERM, CNRS, Montpellier, France

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Denis Mariano-Goulart Département de Médecine Nucléaire, Hôpital Lapeyronie, Centre Hospitalier Régional Universitaire (CHU) Montpellier, Montpellier, France
PhyMedExp, Université de Montpellier, INSERM, CNRS, Montpellier, France

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Helena Huguet Unité de Recherche Clinique et Epidémiologie, Hôpital Lapeyronie, CHU Montpellier, Montpellier, France

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Eric Renard Departement d’Endocrinologie, Diabète, Nutrition, Hôpital Lapeyronie, CHRU Montpellier, Montpellier, France
CIC INSERM 1411, Hôpital Gui de Chauliac, CHU Montpellier, Montpellier Cedex 5, France
Institut de Génomique Fonctionnelle, CNRS UMR 5203/INSERM U661/Université Montpellier, Montpellier, France

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Patrick Lefebvre Departement d’Endocrinologie, Diabète, Nutrition, Hôpital Lapeyronie, CHRU Montpellier, Montpellier, France

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Marie-Christine Picot Unité de Recherche Clinique et Epidémiologie, Hôpital Lapeyronie, CHU Montpellier, Montpellier, France
CIC INSERM 1411, Hôpital Gui de Chauliac, CHU Montpellier, Montpellier Cedex 5, France

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Anne-Marie Dupuy Département de Biochimie, Hôpital Lapeyronie, CHU Montpellier, Montpellier, France

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Jean-Paul Cristol PhyMedExp, Université de Montpellier, INSERM, CNRS, Montpellier, France
Département de Biochimie, Hôpital Lapeyronie, CHU Montpellier, Montpellier, France

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Philippe Courtet Institut de Génomique Fonctionnelle, CNRS, INSERM Université Montpellier, Montpellier, France
Département d’Urgence et Post-Urgence Psychiatrique, Hôpital Lapeyronie, CHU Montpellier, Montpellier, France

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Vincent Boudousq Département de Médecine Nucléaire, Hôpital Carémeau, CHU Nîmes, Nîmes, France

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Antoine Avignon Département Endocrinologie, Nutrition, Diabète, Equipe Nutrition, Diabète, CHU Montpellier, Montpellier, France

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Sébastien Guillaume Institut de Génomique Fonctionnelle, CNRS, INSERM Université Montpellier, Montpellier, France
Département d’Urgence et Post-Urgence Psychiatrique, Hôpital Lapeyronie, CHU Montpellier, Montpellier, France

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Ariane Sultan PhyMedExp, Université de Montpellier, INSERM, CNRS, Montpellier, France
Département Endocrinologie, Nutrition, Diabète, Equipe Nutrition, Diabète, CHU Montpellier, Montpellier, France

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products; IGF-1, insulin-like growth factor-1; OC, osteocalcin; PINP, procollagen type I N-terminal propeptide; Z-score, the number of s.d. above or below the mean for the patient’s age, sex and ethnicity. Bold indicates statistical significance

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Elena Valassi Endocrinology/Medicine Department, Hospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), IIB-Sant Pau, ISCIII and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain

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Natalia García-Giralt URFOA, IMIM (Institut Hospital del Mar d’Investigacions Mèdiques), Universitat Autònoma de Barcelona, Barcelona, Spain

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Jorge Malouf Mineral Metabolism Unit, Medicine Department, Hospital Sant Pau, Barcelona, Spain

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Iris Crespo Endocrinology/Medicine Department, Hospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), IIB-Sant Pau, ISCIII and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain

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Jaume Llauger Radiology Department, Hospital Sant Pau, Barcelona, Spain

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Adolfo Díez-Pérez URFOA, IMIM (Institut Hospital del Mar d’Investigacions Mèdiques), Universitat Autònoma de Barcelona, Barcelona, Spain

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Susan M Webb Endocrinology/Medicine Department, Hospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), IIB-Sant Pau, ISCIII and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain

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Introduction Growth hormone (GH) and insulin-like growth factor-I (IGF1) are anabolic hormones which influence bone metabolism through the modulation of several signaling pathways ( 1 ). In vitro studies showed that GH enhances the

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Ananda A Santana-Ribeiro Laboratory of Motor Control and Body Balance, Center for Health Science Research, Federal University of Sergipe, Sergipe, Brazil

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Giulliani A Moreira-Brasileiro Laboratory of Motor Control and Body Balance, Center for Health Science Research, Federal University of Sergipe, Sergipe, Brazil
Department of Physical Therapy and Post-Graduate Program in Health Science, Federal University of Sergipe, The GREAT Group (GRupo de Estudos em ATividade física), Sergipe, Brazil

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Manuel H Aguiar-Oliveira Division of Endocrinology, Federal University of Sergipe, Aracaju, Sergipe, Brazil

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Roberto Salvatori Division of Endocrinology, Diabetes and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

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Vitor O Carvalho Department of Physical Therapy and Post-Graduate Program in Health Science, Federal University of Sergipe, The GREAT Group (GRupo de Estudos em ATividade física), Sergipe, Brazil

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Claudia K Alvim-Pereira Laboratory of Motor Control and Body Balance, Center for Health Science Research, Federal University of Sergipe, Sergipe, Brazil

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Carlos R Araújo-Daniel Department of Statistic and Actuarial Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil

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Júlia G Reis-Costa Laboratory of Motor Control and Body Balance, Center for Health Science Research, Federal University of Sergipe, Sergipe, Brazil

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Alana L Andrade-Guimarães Laboratory of Motor Control and Body Balance, Center for Health Science Research, Federal University of Sergipe, Sergipe, Brazil
Department of Physical Therapy and Post-Graduate Program in Health Science, Federal University of Sergipe, The GREAT Group (GRupo de Estudos em ATividade física), Sergipe, Brazil

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Alécia A Oliveira-Santos Division of Endocrinology, Federal University of Sergipe, Aracaju, Sergipe, Brazil

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Edgar R Vieira Department of Physical Therapy and Neuroscience, Wertheims’ College of Nursing and Health Science, Florida International University, Miami, Florida, USA

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Miburge B Gois-Junior Laboratory of Motor Control and Body Balance, Center for Health Science Research, Federal University of Sergipe, Sergipe, Brazil
Department of Physical Therapy and Post-Graduate Program in Health Science, Federal University of Sergipe, The GREAT Group (GRupo de Estudos em ATividade física), Sergipe, Brazil
Department of Physical Therapy and Neuroscience, Wertheims’ College of Nursing and Health Science, Florida International University, Miami, Florida, USA

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, OMIM n. 612781), resulting in low serum GH and IGF-I throughout their life ( 12 ). Although these individuals are severely short, with reduced lean body mass and increased fat percentage, they perform vigorous daily physical activities such as pottery

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Christian Høst Department of Endocrinology and Internal Medicine and the Medical Research Laboratories, Clinical Institute, Aarhus University Hospital, Aarhus N, Denmark
Department of Pediatrics, Aarhus University Hospital, Aarhus N, Denmark

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Anders Bojesen Department of Clinical Genetics, Aarhus University Hospital, Aarhus N, Denmark

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Mogens Erlandsen Section for Biostatistics, Department of Public Health, Aarhus University, Aarhus C, Denmark

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Kristian A Groth Department of Molecular Medicine, Aarhus University Hospital, Aarhus N, Denmark

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Kurt Kristensen Department of Pediatrics, Aarhus University Hospital, Aarhus N, Denmark

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Anne Grethe Jurik Department of Radiology, Aarhus University Hospital, Aarhus N, Denmark

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Niels H Birkebæk Department of Pediatrics, Aarhus University Hospital, Aarhus N, Denmark

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Claus H Gravholt Department of Endocrinology and Internal Medicine and the Medical Research Laboratories, Clinical Institute, Aarhus University Hospital, Aarhus N, Denmark
Department of Molecular Medicine, Aarhus University Hospital, Aarhus N, Denmark

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.4 3.9 ± 1.6 <0.0001 SHBG (nmol/L) 31.6 ± 13.8 24.5 ± 10.6 0.001 30.3 ± 9.6 0.8 Hemoglobin (mmol/L) 8.7 ± 0.6 9.0 ± 0.6 0.05 9.6 ± 0.6 0.001 IGF-I (µg/L) 163 ± 51 178 ± 47 0.03 165 ± 54 0.9 IGFBP-3

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