NPPB and Insulin resistance: Adult patients with established GHD have an increased risk of cardiovascular disease and early mortality (2), and the condition has been associated with an unfavorable lipid profile, an increase in body fat, an increase in Homeostasis Model Assessment of Insulin Resistance index (HOMA-IR), early arteriosclerosis and a decrease in fibrinolytic activity (3–6), a reduction in left ventricular mass (LVM), a smaller idle and after-stress ejection fraction (EF), diastolic dysfunction, and an increase in brain natriuretic peptide (BNP) levels (7).