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Stroke, Cardiac Disease and Diabetes Mellitus in Hypopituitarism« Back to Volume 24, Issue 1, May 2008 - Table of Contents The impact of long-term growth hormone deficiency (GHD) and of long-term growth hormone (GH) treatment on cerebrovascular and cardiovascular diseases and diabetes mellitus is unknown. Holmer et al evaluated the incidence of nonfatal stoke and cardiac events and the prevalence of type 2 diabetes mellitus (T2DM) in a cohort of GHD patients and healthy controls. The authors also studied the effects of cardioprotective drugs and 6 years of GH-replacement treatment in this population. The incidence of nonfatal stroke and cardiac events was estimated retrospectively from questionnaires in 750 GHD patients (53% males and 47% females) and in 2314 matched population controls. GHD patients were recruited from the departments of endocrinology at all Swedish University hospitals and one county hospital. All patients were diagnosed as having severe GHD by dynamic testing (peak GH <3 mcg/L). The lifelong incidence of nonfatal stroke was tripled in GHD women and doubled in GHD men. A decline was noted in both genders following the detection of the first pituitary hormone deficiency and GHD, a period of time during which most patients received GH therapy. The lifelong incidence of nonfatal cardiac events declined in GHD men; GHD women had a higher prevalence of T2DM. Women were twice as likely to be taking lipid-lowering drugs as the population controls, while GHD men had a 28% higher prevalence for the use of antihypertensive medication. The authors concluded that the decreased risk of nonfatal stroke in both genders and of nonfatal cardiac events in GHD men may be due to the larger prescription of cardioprotective drugs and to 6 years of GH-replacement. The increased prevalence of T2DM in GHD women can be partly attributed to a higher body mass and to decreased physical activity. Editor’s CommentAn increased incidence of cerebrovascular and cardiovascular mortality in patients with hypopituitarism on conventional hormone treatment, but without GH therapy, has been reported in recent epidemiological studies.1,2 GHD is believed to be responsible for the early atherogenesis in hypopituitarism, as cardiovascular risk factors have been improved with GH treatment in this group of patients. Glucose intolerance, T2DM, and hypertension are increased in GHD.3 Diastolic blood pressure tends to decrease with GH treatment, while insulin sensitivity is impaired following initial GH replacement, but may improve later as fat mass is reduced. This study showed that hypopituitary patients had a higher lifelong incidence of nonfatal stroke (triple in GHD women and double in GHD men), although cerebrovascular events decreased in men and women during the periods following the diagnosis and the treatment of the pituitary hormone deficiencies and of GHD. This decline was probably due to the long-term use of GH and the replacement of thyrosine and glucocorticoids. Additionally, patients may also benefit from the increased administration of lipid-lowering and antihypertensive medications. The increased prevalence of T2DM in GHD women could not be attributed to overtreatment with GH as the IGF-I level was at mid range. Additionally, acromegaly and Cushing’s disease were excluded in these patients, thus the increased prevalence of T2DM was partly attributed to their higher BMI and their lower physical activity. Long- term surveillance for cardiovascular disease and T2DM seems necessary in hypopituitary patients; the institution of appropriate treatment with hormone replacement and cardioprotective drugs plays a positive role in decreasing the risk of nonfatal stroke and the risk of nonfatal cardiac events in men; an increased prevalence of T2DM seems to be present in GHD women. Roberto Lanes, MD References - (linked to
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Volume 24 Number 1
May 2008
www.GGHjournal.com
ISSN 1932-9032
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