Endocrine Abstracts

Introduction: Cardiovascular diseases are frequent in patients with hypopituitarism receiving conventional hormone replacement therapy. They represent the main cause of premature death in this population. Emerging evidence smggests that beyond traditional risk factors, evaluating coronary calcium score (CCS) and inflammatory markers such as high-sensitivity C-reactive protein (hs-CRP) provides valuable insights into cardiovascular health in this population. The aims of the present study were to assess the cardiovascular risk (CVR) and to determine CCS in women with hypopituitarism.

Methods: We conducted a cross-sectional study including 50 patients with complete anterior hypopituitarism secondary to Sheehan syndrome (SS), receiving conventional hormone replacement therapy (PG) and an equal number of age- and body-mass index (BMI)-matched women controls (CG). Participants underwent a clinical examination, laboratory tests, and a coronary computed tomography scan to calculate the CCS.

Results: The average age was 62.2±9.4 years in the PG and 60.6±8.4 years in the CG (P=0.385). The average delay between postpartum hemorrhage and the diagnosis of SS was 11.1±9.4 years and its average duration was 31.6±9.9 years. The prevalence of hypertension (PG: 78%, CG: 64%, P=0.123), insulin resistance (PG: 38%, CG: 56%, P=0.070), and diabetes (PG: 24%, CG: 14%, P=0.202) were comparable between the two groups. Dyslipidemia (PG: 66%, CG: 38%, P=0.005) and metabolic syndrome (PG: 64%, CG: 40%, P=0.016) were more prevalent in the PG. PG had higher hs-CRP levels (7.6 mg/l vs 2.5 mg/l, respectively; P<0.001) and higher CCS (47.3 vs 6.9, respectively; P=0.009) than controls. Two patients had coronary artery disease. No women from the CG had a cardiovascular accident. Based on a CCS>10, 28% of PG had high CVR compared to 18% of controls (P<0.001). Factors associated with high CVR included age >55 years (OR= 1.5; IC95%: 1.25-1.95; P=0.039) and hypertension (OR=1.6; IC95%: 1.3-2.1; P=0.016). On the other hand, no relationship was observed between high CVR, disease-related parameters, and hormone replacement therapy.

Conclusion: Women with hypopituitarism secondary to SS had a higher CVR than controls. They necessitate a more exhaustive risk assessment strategy by incorporating CCS and inflammatory markers into the evaluation process. Preventive and therapeutic strategies should be early developed to mitigate the cardiovascular consequences associated with SS.