Prevalence and characteristics of the metabolic syndrome in 2479 hypopituitary patients with adult-onset GH deficiency before GH replacement: a KIMS analysis

Abstract

Objective: An increased risk of cardiovascular morbidity and mortality in adult GH deficiency (GHD) may be related to hypopituitarism but also to the presence of the metabolic syndrome (MetS). Our objective was to investigate the characteristics and prevalence of MetS as well as its comorbidities in adult GHD. Design: In KIMS (Pfizer International Metabolic Database) 2479 patients with severe adult-onset GHD, naïve to GH replacement, with complete information on all MetS components were found. MetS was defined according to the National Cholesterol Education Program's Adult Treatment Panel III (NCEP) and the International Diabetes Foundation (IDF). Methods: The prevalence of MetS was calculated and compared with previously published data from the normal population. Associations were assessed between background variables, baseline variables, comorbidities, and MetS. Results: MetS was present in 43.1% (NCEP) and in 49.1% (IDF) of patients, clearly higher than data from the normal population (20-30%). MetS prevalence was related to age, GHD duration, and body mass index (BMI), but not to GHD severity, extent of hypopituitarism, or etiology of pituitary disease. Adjusted for age, gender, and BMI, patients with MetS had a higher prevalence ratio for diabetes mellitus: 4.65 (95% confidence interval (CI): 3.29-6.58), for cardiovascular morbidity: 1.91 (95% CI: 1.33-2.75), and for cerebrovascular morbidity: 1.77 (95% CI: 1.09-2.87) than patients without MetS. Conclusions: MetS is highly prevalent in GHD and is associated with a higher prevalence ratio for comorbidities. The presence of MetS in GHD may therefore contribute to the increased risk of cardiovascular morbidity and mortality found in these patients.

Prevalence of diabetes mellitus in 6050 hypopituitary patients with adult-onset GH deficiency before GH replacement: a KIMS analysis

“…This was apparent in both genders, but crude analysis and regression analysis showed that it occurred at a slower pace compared with the increase in the reference population. This latter observation could be due to the fact that in the general reference population diabetes prevalence is relatively low in young adults, resulting in an elevated SPR, and to the increased prevalence of risk factors for diabetes in GHD patients, as reported previously (23). Other factors related to a younger age, such as a profound clinical impact of obesity inducing a more rapid insulin resistance, have been proposed (24).…”

Metabolic alterations in patients who develop traumatic brain injury (TBI)-induced hypopituitarism

“…Hypopituitarism, and in particular GHD are associated with several metabolic alterations and cardiovascular risk [6][7][8]17,[23][24][25][26].This brief report showed that also in hypopituitarism due to TBI metabolic impairment is frequent, in particular altered glucose levels, insulin resistance and dyslipidemia, independently by BMI.…”

“…In particular, altered body composition, insulin resistance, hypertension, unfavorable lipid profile, endothelial dysfunction and atherosclerosis has been reported in several studies on treatment of naïve GH deficient patients along time [6][7][8][11][12][13][14][15][16]. Accordingly, also metabolic syndrome prevalence is present in GH deficient patients and may therefore contribute to the increased risk of cardiovascular morbidity and mortality found in these patients [17].…”

Rationale and design of PATRO Adults, a multicentre, noninterventional study of the long-term efficacy and safety of Omnitrope® for the treatment of adult patients with growth hormone deficiency

“…Adults with GHD also present with metabolic abnormalities that resemble those of the metabolic syndrome [Johansson and Bengtsson, 1999], which itself is a strong predictor of T2DM risk. Data from other surveillance studies of patients treated with recombinant hGH indicate that the prevalence of the metabolic syndrome is higher in GHD patients (40-50%) than in the general population (20-30%) [Attanasio et al 2010;Verhelst et al 2011]. In one study, while prevalence was unaffected by GH replacement therapy, baseline metabolic syndrome status or obesity were strong predictors of the metabolic syndrome after 3 years of GH treatment [Attanasio et al 2010].…”