Cardiovascular disease and risk factors in adults with hypopituitarism

Beshyah, Salem A.; Johnston, Desmond G.

doi:10.1046/j.1365-2265.1999.00682.x

Cited by 119 publications

(94 citation statements)

References 143 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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“…Increased mortality ratio is observed in both CD (1) and hypopituitary patients without GH replacement (21)(22)(23)(24)(25), most often related to cardio-and cerebrovascular risk factors. GH replacement has been shown to improve the adverse body composition, cardiovascular risk factors (25,26), and poor QoL associated with GHD (27,28).…”

Section: Analysis Bmentioning

confidence: 99%

Clinical features of GH deficiency and effects of 3 years of GH replacement in adults with controlled Cushing's disease

Höybye¹,

Ragnarsson²,

Jönsson³

et al. 2010

European Journal of Endocrinology

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Objective: Patients in remission from Cushing's disease (CD) have many clinical features that are difficult to distinguish from those of concomitant GH deficiency (GHD). In this study, we evaluated the features of GHD in a large cohort of controlled CD patients, and assessed the effect of GH treatment. Design and methods: Data were obtained from KIMS, the Pfizer International Metabolic Database. A retrospective cross-sectional comparison of background characteristics in unmatched cohorts of patients with CD (nZ684, 74% women) and nonfunctioning pituitary adenoma (NFPA; nZ2990, 39% women) was conducted. In addition, a longitudinal evaluation of 3 years of GH replacement in a subset of patients with controlled CD (nZ322) and NFPA (nZ748) matched for age and gender was performed. Results: The cross-sectional study showed a significant delay in GHD diagnosis in the CD group, who had a higher prevalence of hypertension, fractures, and diabetes mellitus. In the longitudinal, matched study, the CD group had a better metabolic profile but a poorer quality of life (QoL) at baseline, which was assessed with the disease-specific questionnaire QoL-assessment of GHD in adults. After 3 years of GH treatment (mean dose at 3 years 0.39 mg/day in CD and 0.37 mg/day in NFPA), total and low-density lipoprotein cholesterol decreased, while glucose and HbAlc increased. Improvement in QoL was observed, which was greater in the CD group (K6 CD group versus K5 NFPA group, P!0.01). Conclusion: In untreated GHD, co-morbidities, including impairment of QoL, were more prevalent in controlled CD. Overall, both the groups responded similarly to GH replacement, suggesting that patients with GHD due to CD benefit from GH to the same extent as those with GHD due to NFPA.

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“…This is likely related to the direct and indirect effects, such as hypercoagulability, abdominal obesity, insulin resistance, impairment in lipid profile, atherosclerosis, endothelial dysfunction, reduction of pulmonary function and muscle performance, of GH and IGF-I on the cardiovascular system (13,14).…”

Section: Cardiac Involvement In Gh Deficiencymentioning

confidence: 99%

The heart: an end-organ of GH action

Colao

Vitale

Pivonello

et al. 2004

European Journal of Endocrinology

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Several experimental and clinical studies have indicate that the heart is an end-organ of GH action. Patients with either childhood-or adulthood-onset GH deficiency (GHD) have abnormalities of cardiac structure and function, such as reduced cardiac mass, impaired diastolic filling and reduced left ventricular response at peak exercise. These cardiovascular abnormalities can be reversed, at least partially, after GH replacement therapy. On the other hand, the chronic overproduction of GH and IGF-I in acromegaly leads to the development of a specific cardiomyopathy. Concentric cardiac hypertrophy occurs in more than two-thirds of patients at diagnosis and is commonly associated with diastolic dysfunction. In later stages, impaired systolic function ending in heart failure can occur if GH/IGF-I excess is not controlled. Additionally, acromegalic cardiomyopathy is complicated by abnormalities of cardiac rhythm and cardiac valves. Successful control of acromegaly is accompanied by a decrease of the left ventricular mass and improvement of cardiac function. These beneficial effects appear earlier in young patients with short disease duration than in elderly patients. In conclusion, GH and IGF-I play a main role in the regulation of cardiac development and performance.European Journal of Endocrinology 151 S93-S101

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Cardiovascular disease and risk factors in adults with hypopituitarism

Cited by 119 publications

References 143 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

Clinical features of GH deficiency and effects of 3 years of GH replacement in adults with controlled Cushing's disease

The heart: an end-organ of GH action

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