A 24-hour comparison of serum growth hormone concentrations in patients with heart failure versus healthy controls.

STUDY OBJECTIVE: To compare endogenous serum growth hormone concentrations over a 24-hour period in patients with chronic heart failure (CHF) and matched controls. DESIGN: Prospective, 24-hour, endogenous concentration comparison. SETTING: Hospital research center. PATIENTS: Eight evaluable patients with nonischemic dilated cardiomyopathy and 10 healthy control subjects, matched for age and sex. INTERVENTION: Over a 24-hour period, blood was drawn from the study participants every 20 minutes for determination of growth hormone. MEASUREMENTS AND MAIN RESULTS: For each patient, the area under the concentration-time curve from time 0-24 hours (AUC0-24), maximum concentration (Cmax), and minimum concentration (Cnadir) of growth hormone were determined. The AUC0-24 and Cmax were 74% (p < 0.05) and 62% (p < 0.05) lower in patients with CHF than in controls, respectively. The Cnadir for all participants was 0 microg/L. Variability in growth hormone concentrations over the 24 hours was considerable for all study participants. CONCLUSIONS: Growth hormone concentrations are suppressed over a 24-hour period in patients with CHF versus healthy controls. Variability in levels throughout the day suggests that a single point evaluation cannot be used to determine deficiency or abundance of growth hormone.

Spontaneous coronary artery dissection in a young woman precipitated by retching.

Spontaneous coronary artery dissection as a cause of acute myocardial ischemia is a rare entity that has been associated with several different clinical profiles and precipitating events. The recognition of this entity as the cause of acute ischemia is important because the therapeutic considerations may be different than that for ischemia due to a ruptured atherosclerotic plaque. We report a case of spontaneous coronary artery dissection in a 31-year-old female that was induced by prolonged, forceful retching. To our knowledge, this is the first reported case of such an association. Prolonged retching should be added to the list of causes of spontaneous coronary artery dissection.