Premature mortality due to cardiovascular disease in hypopituitarism

Rosén, Thord; Bengtsson, Bengt‐Åke

doi:10.1016/0140-6736(90)91812-o

Cited by 1,342 publications

(845 citation statements)

References 12 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: 69%

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: 69%

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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“…Furthermore, there is evidence that untreated adult GHD patients have increased risk of premature death from cardiovascular diseases (2). Many studies performed in GHD adults suggest that these patients benefit from GH replacement therapy (1,3 adults (2). In this study, both parameters were restored by the administration of rhGH and CS with or without T4.…”

Section: Introductionsupporting

confidence: 54%

“…And GHD has not been treated either in GHD children once they have reached adulthood or in patients with adult-onset hypopituitarism, but it has been found by various research groups that many symptoms such as abnormalities in body composition and lipid metabolic derangements are associated with GHD in adults (1). Furthermore, there is evidence that untreated adult GHD patients have increased risk of premature death from cardiovascular diseases (2). Many studies performed in GHD adults suggest that these patients benefit from GH replacement therapy (1,3 adults (2).…”

Section: Introductionmentioning

confidence: 99%

Effects of Human GH on Lipid Metabolism in Hypophysectomized Mature Rats (II)

Sekine¹,

Seki²,

Hara³

et al. 1997

Clin Pediatr Endocrinol

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“…Rosen and Bengtsson24 first documented premature mortality due to cardiovascular disease in a seminal publication in 1990. The study by Tomlinson found a standardized mortality ratio (SMR) of 1·87 in hypopituitary patients compared to the external population 16.…”

Section: Discussionmentioning

confidence: 99%

ACTH and gonadotropin deficiencies predict mortality in patients treated for nonfunctioning pituitary adenoma: long‐term follow‐up of 519 patients in two large European centres

O’Reilly

Reulen

Gupta

et al. 2016

Clinical Endocrinology

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SummaryContext and ObjectiveNonfunctioning pituitary adenomas (NFPAs) are the most common subtype of pituitary tumour. Hypopituitarism is observed in NFPAs due to tumour‐ or treatment‐related factors and may increase mortality risk. Here, we analysed the associations of hypopituitarism, hormone replacement and mortality in a large NFPA cohort derived from two large European centres.Design, Setting and ParticipantsCase note review of all patients treated for NFPA in University Hospitals Birmingham and Beaumont Hospital Dublin between 1999 and 2014 was performed.Main Outcome MeasuresClinical presentation, treatment strategies, pituitary function and vitality status were recorded in each patient. A multivariate Cox regression model was used to examine the association between hypopituitarism, hormone replacement and premature mortality.ResultsA total of 519 patients were included in the analysis. Median duration of follow‐up was 7·0 years (0·5–43). A total of 81 deaths were recorded (15·6%). On multivariate analysis, adrenocorticotropic hormone (ACTH) and gonadotropin (Gn) deficiencies were associated with an increased relative risk of death (OR 2·26, 95% CI 1·15–4·47, P = 0·01 and OR 2·56, 95% CI 1·10–5·96, P = 0·01, respectively). Increased hydrocortisone (HC) (P‐trend = 0·02) and lower levothyroxine (LT4) doses (P‐trend = 0·03) were associated with increased risk of death. Mortality increased with the degree of pituitary failure observed (P‐trend = 0·04).ConclusionACTH and gonadotropin‐deficient patients have higher mortality rates compared to those with intact hormonal axes. Excessive HC and suboptimal LT4 replacement may also increase risk of death. Complex associations between hormone deficiency and replacement underpin the increased mortality risk in NFPA patients.

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Premature mortality due to cardiovascular disease in hypopituitarism

Cited by 1,342 publications

References 12 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

Effects of Human GH on Lipid Metabolism in Hypophysectomized Mature Rats (II)

ACTH and gonadotropin deficiencies predict mortality in patients treated for nonfunctioning pituitary adenoma: long‐term follow‐up of 519 patients in two large European centres

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