<b>Increased cerebrovascular mortality in patients with hypopituitarism</b>

Bülow, Birgitta; Hagmar, Lars; Mikoczy, Zoli; Nordström, Carl‐Henrik; Erfurth, Eva Marie

doi:10.1046/j.1365-2265.1997.d01-1749.x

Cited by 509 publications

(377 citation statements)

References 19 publications

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“…Epidemiological studies have shown that this abdominal obesity is a risk factor for development of metabolic abnormalities leading to cardiovascular complications [4,5]. In studies in Japanese adult patients with GHD it has been shown that there is an increased risk of cardio-and cerebro-vascular morbidity and mortality compared to the normal population [6][7][8], similar to that previously shown in Caucasian patients [5,[9][10][11].…”

supporting

confidence: 64%

Growth Hormone (GH) Effects on Central Fat Accumulation in Adult Japanese GH Deficient Patients: 6-month Fixed-dose Effects Persist during Second 6-month Individualized-dose Phase

et al. 2006

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Abstract. Both Japanese and Caucasian adults with GH deficiency (GHD) have pronounced abdominal obesity, which is associated with increased risk of cardiovascular complications. We investigated the effects of GH treatment in 27 adult Japanese GHD patients, 15 with adult onset (AO) and 12 with childhood onset (CO) GHD. Patients initially received GH titrated to 0.012 mg/kg/day for 24 weeks in a double-blind design and the dose was then individualized for each patient according to IGF-I for a further 24 weeks. Dual-energy x-ray absorptiometry (DXA) data were evaluated for percentages of trunk fat, total body fat and lean body mass. Serum IGF-I and lipid concentrations were determined at a central laboratory. There were 25 patients who completed 48 weeks of treatment, with 7, 6 and 12 patients then receiving GH at 0.003, 0.006 and 0.012 mg/kg/day, respectively. With the reductions in dose when individualized between weeks 24 and 48, mean serum IGF-I level was reduced and excessively high values, observed in AO patients on the fixed GH dose, were no longer seen. The decrease from baseline in trunk fat was similar at week 24 (-3.8 ± 3.3%, p<0.001) and week 48 (-3.1 ± 3.7%, p<0.001), and the difference between changes was not significant. Total cholesterol was decreased from baseline by -24 ± 28 mg/dl (p<0.001) at week 24 and -17 ± 28 mg/dl (p = 0.007) at week 48. Two patients had elevated HbA1c levels: one continued GH treatment after a dose reduction and the other discontinued due to persistent impaired glucose tolerance. Therefore, excessively high IGF-I levels can be avoided by individualized dosing during long-term GH treatment. Individualized dosing maintains the decrease in abdominal fat in adult Japanese GHD patients and should reduce the cardiovascular risk.

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supporting

confidence: 64%

Growth Hormone (GH) Effects on Central Fat Accumulation in Adult Japanese GH Deficient Patients: 6-month Fixed-dose Effects Persist during Second 6-month Individualized-dose Phase

et al. 2006

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“…16,25,26,30 ± 32 There is no clear explanation for this observation, although GH de®ciency has been proposed as the most possible explanation. 18,19 Our hypopituitary patients had signi®cantly higher triglyceride, total and LDL cholesterol and signi®cantly lower HDL cholesterol concentrations. This lipid pro®le constitutes a vascular risk.…”

Section: Discussionmentioning

confidence: 67%

“…When given conventional replacement therapy, patients with hypopituitarism show an increased mortality from cardiovascular disease 18,19,29 and increased prevalence of cardiovascular risk factors. 16,25,26,30 ± 32 There is no clear explanation for this observation, although GH de®ciency has been proposed as the most possible explanation.…”

Section: Discussionmentioning

confidence: 99%

“…13,14 Patients with hypopituitarism (particularly women) receiving conventional replacement therapy have higher cardiovascular mortality and morbidity than the general population. 18,19 Premature atherosclerosis of the peripheral arteries and the aorta, 20 myocardial dysfunction and abnormal exercise tolerance 21,22 have been described in symptom-free hypopituitary patients. The mechanisms of increased vascular disease in hypopituitarism and the causal relationship to GH de®ciency are unclear.…”

Section: Introductionmentioning

confidence: 99%

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Serum lipid and leptin concentrations in hypopituitary patients with growth hormone deficiency

Özbey

Algün

et al. 2000

Int J Obes

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OBJECTIVE: To investigate the effects of growth hormone (GH) de®ciency on serum lipid and leptin concentrations in hypopituitary patients taking conventional replacement therapy and to determine the relations between leptin and gender and anthropometric and metabolic variables. SUBJECTS: Twenty-one GH de®cient adult hypopituitary patients (15 women, six men) and 21 (14 women, seven men) age, sex and body mass index (BMI) matched healthy controls. MEASUREMENTS: After an overnight fast, anthropometric parameters were measured and body composition was determined by a bioelectrical impedance analyser. Venous blood samples were obtained for the measurements of glucose, total cholesterol, high density lipoprotein (HDL) cholesterol, triglyceride, intact insulin, insulin-like growth factor 1 (IGF-1) and leptin concentrations. Serum leptin and hormones were analysed by radioimmunoassay. RESULTS: Hypopituitary patients with GH de®ciency showed signi®cantly higher triglyceride, total and low density lipoprotein (LDL) cholesterol and lower HDL cholesterol concentrations on conventional replacement therapy. The unfavourable lipid pro®le was particularly evident in women. Signi®cantly higher leptin concentrations were found in patients compared with healthy controls with similar body fat content (23.5 AE 11.8 ngaml vs 11.7 AE 6.9 ngaml, P 0.01). This difference remained signi®cant even when leptin values were expressed in relation to fat mass percentage (0.79 AE 0.40 vs 0.42 AE 0.17 ngaml%, P`0.05) and fat mass kg (1.32 AE 0.81 vs 0.66 AE 0.30 ngaml kg, P`0.05). Signi®cant positive correlations were observed between leptin concentrations and body fat percentage and age in the control group. In patients the sole signi®cant relation between leptin and study parameters was the positive correlation observed between leptin and total cholesterol concentrations. Serum leptin concentrations were signi®cantly higher in women than men in the control group, but not in the patients. No signi®cant gender difference was observed when leptin concentrations were expressed in relation to fat mass (percentage and kg). CONCLUSION: Growth hormone de®cient hypopituitary patients (particularly women) on conventional replacement therapy have a more atherogenic lipid pro®le. Leptin concentrations are increased in GH de®cient adults even after adjustment for percentage body fat and body fat mass (kg). Although the nature of our data does not allow us to draw any conclusions on the mechanism(s) of increased leptin concentrations in GH de®ciency, decreased central sensitivity to leptin and increased leptin production from per unit fat mass, or alterations in leptin clearance, might be operative.

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“…Pacientes com hipopituitarismo apresentam aumento da mortalidade quando comparados à população geral (4)(5)(6)(7)(8)(9). Alguns estudos demonstraram aumento de mortalidade por causa de doenças cardiovasculares (4,5,8,9).…”

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Aspectos diagnósticos e terapêuticos da síndrome de Sheehan

Soares

Conceição

Vaisman

2008

Arq Bras Endocrinol Metab

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A síndrome de Sheehan se caracteriza pelo hipopituitarismo pós-parto secundário à necrose hipofisária decorrente de hipotensão ou choque em virtude de hemorragia maciça durante ou logo após o parto. Sua freqüência vem caindo em todo o mundo, principalmente em países e regiões mais desenvolvidas em razão da melhora nos cuidados obstétricos, contudo, ainda é freqüente em países em desenvolvimento onde os cuidados obstétricos são mais precários. A síndrome de Sheehan pode evoluir de maneira lenta com diagnóstico muitas vezes tardio e, ainda que alguns sinais de insuficiência hipofisária ocorram, logo após o parto, são pouco valorizados. Seu diagnóstico precoce e o tratamento adequado são importantes para redução da morbimortalidade das pacientes. Esta revisão tem por objetivo descrever aspectos clínicos, laboratoriais e terapêuticos da síndrome de Sheehan, incluindo a nossa experiência pessoal na reposição com GH recombinante neste grupo de pacientes.

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Increased cerebrovascular mortality in patients with hypopituitarism

Cited by 509 publications

References 19 publications

Growth Hormone (GH) Effects on Central Fat Accumulation in Adult Japanese GH Deficient Patients: 6-month Fixed-dose Effects Persist during Second 6-month Individualized-dose Phase

Growth Hormone (GH) Effects on Central Fat Accumulation in Adult Japanese GH Deficient Patients: 6-month Fixed-dose Effects Persist during Second 6-month Individualized-dose Phase

Serum lipid and leptin concentrations in hypopituitary patients with growth hormone deficiency

Aspectos diagnósticos e terapêuticos da síndrome de Sheehan

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