Hypopituitary patients have an increased prevalence of cardiovascular risk factors
Beata Matuszek1, Mariusz Kowalczyk1, Tomasz Zapolski2 & Andrzej Nowakowski1
Introduction: Hypopituitary patients receiving conventional hormone replacement, but without GH replacement, have an increased mortality from cardiovascular diseases. Inadequate hormone replacement is a possible cause of this increased mortality. GH deficiency in adult patients has been associated with several cardiovascular risk factors, including hyperlipidemia, increased abdominal adiposity, and impaired insulin sensitivity.
The aim of the study is an evaluation of patients with GH deficiency with no clinical signs of cardiovascular diseases in the course of multihormonal hypopituitarism with special attention paid to occurrence of the metabolic syndrome markers and cardiovascular risk factors.
Material and methods: The study included 18 patients (13-M and 5-F) within the age range from 21 to 59 years (x=39) with multihormonal hypopituitarism which lasted from 1 to 24 years (x=11.15) and after surgical treatment of a tumour in the hypothalamic-hypophyseal region; patients with acromegaly and Cushings disease were excluded from the study.
In all the studied patients basic constituents of the metabolic syndrome were evaluated: body mass index (BMI), waist, arterial pressure, insulin resistance ratios, HOMAIR and QUICKI, lipidogram, fibrinogen, homocysteine, adiponectin and echocardiography. The control group consisted of 12 healthy individuals.
Results: Hypopituitary patients had an obesity value (P=0.0063), independently of sex and age, with a higher circumference of waist (P<0.0001). Mixed hyperlipidemia was found in 88% of the studied patients, a higher low-density lipoprotein cholesterol (P=0.001), and triglyceridemia (P=0.003). Serum homocysteine was significantly higher (P=0.02) and adiponectin concentration was significantly lower in patients than in controls (P<0.005). Furthermore, the patients had a significantly increased left atrium size (P=0.05), but no difference was observed for other cardiac measure.
Conclusions: In patients with multihormonal hypopituitarism, it is necessary to apply simultaneous replacement treatment with regard to all hormonal deficiencies, including GH. Close monitoring for premature development of the metabolic syndrome risk factors is important, especially in the young.