Patients with hypothalamic-pituitary disease: prevalence of diabetes, hypertension, dyslipidemia and other cardio-vascular risk factors
N Furlong1, D Deepak2 & IA MacFarlane3
Several studies suggest that mortality rates due to cardiovascular disease (CVD) are increased in patients with hypopituitarism. We retrospectively assessed the prevalence of known diabetes, treated hypertension and dyslipidemia, known risk factors for cardiovascular disease (CVD), in a large population (n:250) of patients with hypothalamic-pituitary disease. We then prospectively screened 90 such patients for the following CVD risk factors: obesity, diabetes mellitus, smoking, family history of premature CVD, hypertension and dyslipidemia (UK guidelines).
Of the 250 patients, (median age 54 years (range: 17-88, 55% female) 70% had pituitary tumours (42% non-functioning, 29% other intracranial tumours). Twenty-five had diabetes mellitus (10%), 24% had treated hypertension and, 26% had treated dyslipidemia. Forty-five patients (18%) had established atherosclerotic CVD.
Prospective screening of 90 patients (median age 58 years; range :25-82, 42% female) with hypothalamic-pituitary disease (80% pituitary tumours ,47% non-functioning, 17% other intracranial tumours) revealed a prevalence of obesity (BMI greater than 30 kg per metre square) 48%, diabetes mellitus 8%, smoking 13% and family history of premature coronary heart disease of 17%. Thirty-eight (42%) patients had treated hypertension, of whom 69% and 48% had systolic and diastolic pressures of greater than 140 and greater than 85 mmHg, respectively. In previously 'normotensive' patients, 37.5% had hypertensive blood pressure readings (greater than 140/90 mmHg). In patients with treated dyslipidaemia, 75% and 41% had total- and LDL-cholesterol levels of greater than 5.0 and greater than 3.0 millimol per litre, respectively. 36% of patients had undiagnosed hypercholesterolemia (total cholesterol greater than 5.0 millimol per litre).
Conclusion: There is a high prevalence of diabetes and CVD risk factors in patients with hypothalamic-pituitary disease; many patients are not treated appropriately. In view of the studies suggesting increased CVD mortality in this group, efforts should be made to identify and vigorously treat these risk factors.