Additionally, extracellular fluid volume, glomerular filtration rate and renal plasma flow all increase substantially with GH replacement. In adults with GH deficiency, body fat is excessive and is distributed in a more central (abdominal) than peripheral pattern. With GH replacement, body fat decreases in parallel with the increase in lean body mass; a mean 5kg loss of body fat in the first month of GH replacement therapy has been reported, and this loss is particularly marked from ΓÇÿcentralΓÇÖ sites (Fig. 2.30).