Background: Inadequate glucocorticoid (GC) replacement may be associated with overexposure to GC, which can adversely influence metabolic and cardio-vascular state of hypopituitary growth hormone deficient adult patients (A-GHD). In this study we compared metabolic profile of ACTH insufficient and sufficient patients in A-GHD not treated with GH.
Patients and methods: A cohort of 260 patients (age 48.6±12 years and BMI 28.7±6.6 kg/m2) with hypopituitarism and A-GHD was divided according to ACTH status and analysed for anthropometric and metabolic parameters including lipid status and glucose metabolism. All ACTH insufficient patients were replaced with hydrocortisone (1020 mg/day in divided doses), and for other hormone deficiencies adequately. None of the patients were treated with GH.
Results: In our cohort prevalence of ACTH insufficiency was 75.4%. ACTH insufficiency was more prevalent in males compared to females (59.7% vs 40.5%, P<0.05). Although our patients were overweight with adverse lipid profiles, no differences were found between the two groups in body weight, waist to hip ratio and lipid profile (total, LDL and HDL cholesterol, triglycerides and Lp a). Prevalence of metabolic syndrome defined according to NCEP (3/5) criteria was similar in both groups (33.9% vs 30.7% ACTH suff. vs ACTH insuff. P>0.05). Significant differences were found in glucose metabolism characterized by lower glucose leves at baseline (4.5±0.9 vs 4.8±0.8 mmol/l, P=0.04) and during oral glucose tolerance test (OGTT 75 g) peak (7.7±2.0 vs 8.6±2.1 mmol/l, P=0.006) and area under the curve values (753.3±197.6 vs 851.2±217.8 mmol/l.min P=0.002) calculated using trapezoidal rule. However insulin concentrations at baseline and during OGTT as well as HOMA IR were not significantly different between ACTH sufficient and ACTH insufficient GHD hypopituitary patients.
Conclusion: Adverse metabolic profile in patients with hypoptuitarism and GHD is not significantly influenced by ACTH deficiency state if it is replaced with low to moderate doses of hydrocortisone.
02 Nov 2015 - 04 Nov 2015