Comorbidity and cardiovascular risk factors in adult GH deficiency following treatment for Cushing's disease or non-functioning pituitary adenomas during childhood

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p>Cushing's disease (CD) and non-functioning pituitary adenoma (NFPA) are rare in paediatric patients. The aim of this study was to describe long-term consequences in adults with GH deficiency (GHD) treated for CD or NFPA during childhood.</jats:p></jats:sec><jats:sec><jats:title>Design, patients and methods</jats:title><jats:p>This was a retrospective analysis of data from KIMS (Pfizer International Metabolic Database). Background characteristics, anthropometry and comorbidity were studied in 47 patients diagnosed with childhood-onset (CO)-CD and 62 patients with CO-NFPA. Data from 100 ACTH-sufficient patients with CO-idiopathic hypopituitarism (CO-Idio) were used for comparison. Cardiovascular risk profile was analysed at baseline and at 1 year on GH treatment in a subgroup of patients (17 CO-CD, 24 CO-NFPA and 55 CO-Idio) not receiving GH treatment at study entry.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The median age at diagnosis of pituitary tumour was 14.0 years (range 10–17) in patients with CO-CD and 13.7 years (range 8–17) in CO-NFPA. In addition to GHD, 41% of patients with CO-CD had three or four other pituitary hormone deficiencies compared with 78% of patients with CO-NFPA (<jats:italic>P</jats:italic>&lt;0.001). Eighty-nine per cent of patients with CO-CD had height SDS lower than 0 compared with 61% of patients with CO-NFPA (<jats:italic>P</jats:italic>=0.002). Hypertension was more common in CO-CD compared with CO-Idio (23 vs 9%,<jats:italic>P</jats:italic>=0.018). At 1 year on GH treatment, total- and low-density lipoprotein-cholesterol decreased significantly in CO-CD but not in CO-NFPA.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Adult patients with GHD following treatment for paediatric CD and NFPA have long-term adverse consequences. Despite more severe hypopituitarism in CO-NFPA, patients with CO-CD have more frequently compromised final stature.</jats:p></jats:sec>

Consensus on diagnosis and management of Cushing's disease: a guideline update

“…Conversely, in patients with pre-existing glucose intolerance, it may worsen glucose metabolism. [125][126][127][129][130][131] has not yet been shown in randomized, prospective trials to reverse metabolic syndrome and cardiovascular or cerebrovascular complications. 126…”

Cardiovascular risk profile in growth hormone-treated adults with craniopharyngioma compared to non-functioning pituitary adenoma: a national cohort study

“…Due to the lack of a substantial control group of untreated GH deficient patients with similar aetiology and follow up, it is not possible to officially prove any beneficial effect of GHRT on CV risk profile with this study. However, you might expect that without GHRT blood pressure, BMI, lipid levels and HbA1c would increase in our study population over years due to the GHD (3,4,8,9). Hence, a stable blood pressure or HbA1c, as demonstrated in our patients, could also be interpreted as a positive effect of GHRT.…”

Principios generales de embriología hipofisaria y manifestaciones clínicas de las alteraciones en su desarrollo

“…Se reportan hasta 46 casos de hipopituitarismo por cada 100,000 habitantes 3 y solo el 11% se asocian a alguna disgenesia hipofisaria. A pesar de su curso indolente, el hipopituitarismo no tratado incrementa el riesgo cardiovascular 4 , la osteoporosis y la infertilidad, además de disminuir la calidad de vida. Algunas neoplasias hipofisarias se han empezado a relacionar con alteraciones en la expresión de los genes encargados del desarrollo de la hipófisis.…”