Cardiovascular function and glucocorticoid replacement in patients with hypopituitarism

Dunne, Fidelma; Elliot, Penny; Gammage, Michael D.; Stallard, T. J.; Ryan, Tracy; Sheppard, M. C.; Stewart, Paul M.

doi:10.1111/j.1365-2265.1995.tb02928.x

Cited by 68 publications

(59 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Al-Shoumer et al (60) reported that hypopituitary patients on GC replacement were more insulin resistant in the mornings when HC was administered than in the mornings when no HC was given. In contrast, Dunne et al (61) found no significant difference in blood pressure and glucose metabolism over a 3-month period when reducing the daily dose of HC from 30 to 15 mg. This is in accordance with a report from McConnell et al (62) who found glucose metabolism to be similar in 15 ACTH-insufficient patients who, in a randomized cross-over study, received either i.v.…”

Section: Adrenocorticoid Axismentioning

confidence: 94%

GH replacement in adults: interactions with other pituitary hormone deficiencies and replacement therapies

Filipsson

Johannsson

2009

European Journal of Endocrinology

View full text Add to dashboard Cite

Severe GH deficiency (GHD) in adults has been described as a clinical entity. However, some of the features associated with GHD could be due to unphysiological and inadequate replacement of other pituitary hormone deficiencies. This may be true for glucocorticoid replacement that lacks a biomarker making dose titration and monitoring difficult. Moreover, oral estrogen replacement therapy decreases IGF1 levels compared with the transdermal route, which attenuates the responsiveness to GH replacement therapy in women. In addition, in untreated female hypogonadism, oral estrogen may augment the features associated with GHD in adult women. Important interactions between the hormones used for replacing pituitary hormone deficiency occur. Introducing GH replacement may unmask both an incipient adrenal insufficiency and central hypothyroidism. Therefore, awareness and proper monitoring of these hormonal interactions are important in order to reach an optimal replacement therapy. This review will focus on the complex hormonal interactions between GH and other pituitary hormones in GHD and in GH replacement. European Journal of Endocrinology 161 S85-S95

show abstract

Section: Adrenocorticoid Axismentioning

confidence: 94%

GH replacement in adults: interactions with other pituitary hormone deficiencies and replacement therapies

Filipsson

Johannsson

2009

European Journal of Endocrinology

View full text Add to dashboard Cite

show abstract

“…This has been attributed to loss of b 2 -adrenoceptor-permissive effect of glucocorticoids in the heart due to b 2 -adrenoceptor density reduction, as shown in lymphocytes (13). A myocardial systolic dysfunction, assessed by echocardiography, has been described in patients with panhypopituitarism (14), but it has not been confirmed in other studies (15).…”

Section: Discussionmentioning

confidence: 85%

Regression of cardiac abnormalities after replacement therapy in Addison's disease

Fallo

Betterle

Budano

et al. 1999

European Journal of Endocrinology

View full text Add to dashboard Cite

Objective: To evaluate by echocardiography the cardiac structure and function in patients with primary adrenocortical insufficiency. Design and Methods: Two-dimensionally guided M-mode echocardiograms and spectral Doppler studies were performed in seven consecutive patients with newly diagnosed autoimmune primary adrenal failure before and 4-8 months after an adequate regimen of steroid substitution. Echocardiographic parameters were also studied in ten healthy controls. Results: In the cases with untreated Addison's disease, both left ventricular end-systolic and enddiastolic dimensions were significantly reduced in comparison with those in controls (P < 0.01). Four patients had echocardiographic signs of mitral valve prolapse (MVP) at the anterior leaflet, with no evidence of mitral regurgitation by Doppler echocardiography. Systolic clicks characteristic of MVP were present on auscultation in two of these cases. Left ventricular chamber size normalized, i.e. significantly increased (P < 0.01), and both echocardiographic and physical signs of MVP resolved after steroid substitution in all patients. All other echocardiographic indices were normal before and after treatment. Conclusions: Patients with untreated Addison's disease have cardiac abnormalities which regress after steroid substitution. A valvular-ventricular disproportion due to the hypovolemic state could explain these findings.

show abstract

“…Patients with hypopituitarism have an increased prevalence of conventional cardiovascular risk factors, including obesity with central fat distribution, insulin resistance and dyslipoproteinemia [4]. Endothelial dysfunction and increased intimal-medial thickness (IMT) have also been described in these patients [5]. Until now, despite discrepancies among studies, growth hormone deficiency is the most well-known risk factor [4,6,7] of cardiovascular disease.…”

Section: Introductionmentioning

confidence: 99%

Carotid atheromatic plaque is commonly associated with hypopituitary men

et al. 2010

View full text Add to dashboard Cite

Hypopituitarism increases the risks of many cardiovascular conditions and therefore, patients with this disease are more prone to cardiovascular disease. To our knowledge, there have been few studies on carotid artery plaque in male patients with hypopituitarism in assessing cardiovascular risks. The aim of this study was to specifically compare carotid artery plaque while examining other major cardiovascular risk factors between male patients with hypopituitarism and control subjects. Forty male patients aged 30-70 years with hypopituitarism and forty age, sex-matched control subjects were recruited at the Yonsei University Severance Hospital, Seoul, Korea. Carotid intima media thickness (IMT) and atheromatous plaque, anthropometry, lipid profile, and pituitary hormones were assessed. Atheromatous plaque in the carotid arteries was observed more frequently in patients with hypopituitarism than age-and sex-matched control subjects (59.5% vs. 2.5%, P \ 0.01) without differences of carotid IMTs. Patients with hypopituitarism also exhibited higher waist circumference, waist to hip ratio, total cholesterol and LDL cholesterol than control subjects. In subgroup analysis in male patients with hypopituitarism including GH deficiency, lower testosterone levels were associated with higher waist circumference (r = 0.446, P = 0.033).In conclusion, hypopituitary males exhibit an increased incidence of carotid artery plaque without differences of carotid IMTs, central obesity and higher total cholesterol level. Lower testosterone levels were associated with central obesity-a strong component of a metabolic syndrome, and unsubstituted testosterone deficiency might be an important cardiovascular risk factor in patients with hypopituitarism.

show abstract

Cardiovascular function and glucocorticoid replacement in patients with hypopituitarism

Cited by 68 publications

References 31 publications

GH replacement in adults: interactions with other pituitary hormone deficiencies and replacement therapies

GH replacement in adults: interactions with other pituitary hormone deficiencies and replacement therapies

Regression of cardiac abnormalities after replacement therapy in Addison's disease

Carotid atheromatic plaque is commonly associated with hypopituitary men

Contact Info

Product

Resources

About