Hypopituitarism is associated with premature vascular mortality. Growth hormone (GH) deficiency, over-replacement with glucocorticoid, cranial irradiation and traditional vascular risk factors are possible contributing factors to the excess mortality.
We studied 200 consecutive adult hypopituitary age (mean standard deviation) 51.7 plus/minus 15.3 years, who attended our pituitary clinic between July and December 2002. Hypertension was defined as blood pressure (BP) over 140/90 mmHg. Dyslipidaemia was defined as LDL cholesterol more than 3 millimole/litre and/ or triglyceride (TG) more than 1.9 millimole/litre and / or HDL less than 1 millimole/litre .
84% of patients had pituitary tumours, 79% had pituitary surgery and 26% had cranial irradiation. 60% had severe GH deficiency, of whom 74% were on GH replacement. 83% had corticosteroid deficiency of whom 85% were on 20mg or less of hydrocortisone daily. Diabetes Mellitus or impaired glucose tolerance was present in 11%. 36% had hypertension and 64% of those were on anti-hypertensive treatment with 49% of the treated patients achieving a target BP less than 140/90 mmHg. 68% of patients had dyslipidaemia including 57% with raised LDL cholesterol and 44% with raised TG. 44% of the dyslipidaemic patients were on statin therapy with 59% achieving LDL cholesterol < 3mmol/l. 22% were smokers. 10% were on aspirin.
This study highlights the increased prevalence of cardiovascular risk factors, in particular hypertension and dyslipidaemia which were suboptimally treated. Clinicians should be aware that hypopituitarism is a high risk condition and of the need to aggressively target vascular risks in this patient population, a strategy which we are now implementing in our unit.
22 - 24 Mar 2004
British Endocrine Societies