Erhöhte Prävalenz von Osteoporose und Arteriosklerose bei konventionell substituierter Hypophysenvorderlappeninsuffizienz: Bedarf einer zusätzlichen Wachstumshormonsubstitution?

Abstract

In a retrospective study of 632 patients with pituitary disease we diagnosed pituitary insufficiency without hypersecretion of any pituitary hormone in 122 patients. Patients were substituted with sex hormones (76%), hydrocortisone (74%) and/or L-thyroxine (77%). 76% had additional growth hormone deficiency, as shown by an increase of growth hormone of less than 5 ng/ml after i.v. administration of L-arginine. In 17% of all patients the diagnosis of osteoporosis was proven or suspected radiologically. 57% had low bone mass of lumbar spine (dualphotonabsorptiometry) and 73% had low bone mass of the proximal forearm (singlephotonabsorptiometry). BMD values of pituitary insufficient patients were in the same range as those of patients with established osteoporosis. More than half of all patients (53%) complained of tiredness, exhaustion and muscle weakness. 40% suffered from adipositas. 77% had hyperlipidemia (68% hypertriglyceridemia and 42% hypercholesterinemia), 18% had hypertension. 14% of the patients had arteriosclerotic events in their history (myocardial infarction or stroke). These figures are higher than incidences shown in the German PROCAM-study. These data show an increased prevalence of osteoporosis and vascular diseases. This is in contrast to the general opinion, that patients with pituitary insufficiency are adequately treated by substitution with adrenal, thyroid and sex hormones. Whether other factors such as the additional growth hormone deficiency are responsible for these diseases has to be examined in prospective studies.

Bone mineral content and bone metabolism during physiological GH treatment in GH-deficient adults--an 18-month randomised, placebo-controlled, double blinded trial

“…A retrospective epidemiological study (6), a cross-sectional radiological study of vertebral heights in GHD patients (7), and data from a pharmacovigiliance study (8) have substantiated the concern by documenting an increased fracture rate in hypopituitary patients. A significant correlation has been found between GH status expressed as peak GH at stimulation test and IGF-I and bone mineral status of lumbar spine and femoral neck (5).…”

Serum Total IGF-I, Free IGF-I, and IGFBP-1 Levels in an Elderly Population

“…26 Other investigations have also suggested that low circulating IGF-I levels are associated with premature atherogenesis, cardiovascular morbidity, and mortality. 27,28,29 However, these latter studies need to be considered with caution because they were retrospective studies; many subjects in these studies also showed deficiencies of other pituitary hormones, which might have been suboptimally replaced.…”

Increased fracture frequency in adult patients with hypopituitarism and GH deficiency

“…A reduced peak bone mass might explain the low bone mineral density among the patients with childhood-onset GHD, but the cause of the osteopenia in the adult-onset GHD is not fully understood. Furthermore, the incidence rate of fractures in hypopituitary patients with adult-onset GHD is not known, although a previous study has indicated an increased risk for osteoporotic vertebral fractures in hypopituitary patients compared with normals (3). We have studied the prevalence of a history of fractures in 107 patients with adult-onset hypopituitarism including GHD with conventional hormonal replacement therapy, except growth hormone (GH).…”