Effect of long-term GH replacement therapy on cardiovascular outcomes in GH-deficient patients previously treated for acromegaly: a sub-analysis from the Dutch National Registry of Growth Hormone Treatment in Adults

Bunderen, Christa C. van; Varsseveld, N. C. van; Heymans, Martijn W.; Franken, Anton; Koppeschaar, H. P. F.; Lely, Aart Jan van der; Drent, Madeleine L.

doi:10.1530/eje-14-0515

Cited by 11 publications

(12 citation statements)

References 41 publications

(95 reference statements)

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“…GH deficiency develops more frequently in patients with ACRO treated with surgery and radiotherapy than in patients NFA who are treated in the same way. It is known that, in addition to the classic hormones, GH deficiency also leads to abnormal body composition (increased fat mass, decreased lean mass), reduction in bone mass density, and decreased quality of life, as well as increased cardiovascular risk [16].…”

Section: Discussionmentioning

confidence: 99%

Markers of Metabolic Syndrome in Patients with Pituitary Adenoma: A Case Series of 303 Patients

et al. 2019

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To assess the demographic characteristics and hormonal status of patients who presented to our clinic with pituitary adenoma and to demonstrate the presence, prevalence, and relationship of metabolic syndrome parameters in these patients. The study included 303 patients with known or newly diagnosed pituitary adenoma and 52 age- and sex-matched healthy controls. The patients were classified into 3 groups; acromegaly (ACRO) (n=54),prolactinoma (PRLoma) (n=163), and non-functional adenoma (NFA) (n=86). in 55.6% (n=172) and 52% (n=163) of the patients, respectively. The waist circumference of all patients (p<0.001) and body mass index (BMI) of patients with PRLoma (p=0.03) and ACRO (p<0.001) were found to be significantly higher than in the controls. The HbA1c, insulin and HOMA-IR values were significantly higher in the ACRO and PRLoma groups, whereas the insulin and HOMA-IR values were significantly higher in the NFA group compared with the control group (p<0.001 and p<0.001, respectively). When the 3 patient groups were compared, waist circumference and BMI were significantly higher in the ACRO group than in the PRLoma group (p=0.04 and p=0.03, respectively). In patients developing pituitary failure after treatment, age, waist circumference, plasma glucose, low-density lipoproteins and triglyceride values were significantly increased when compared with those without pituitary failure after treatment (p<0.001). In our study, it was found that there was increased metabolic and cardiovascular risk in functional pituitary adenoma and NFA.

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Section: Discussionmentioning

confidence: 99%

Markers of Metabolic Syndrome in Patients with Pituitary Adenoma: A Case Series of 303 Patients

et al. 2019

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“…Studies using large data bases including the KIMS database [20, 52] and the Dutch National Registry of Growth Hormone Treatment [53] have also demonstrated improvements in lipid levels [20, 53] and quality of life in individuals with acroGHD but an increase in cardiovascular mortality was demonstrated in the individuals with acroGHD treated with GH in the KIMS database compared to those treated for GHD with a history of a non-functioning pituitary adenoma. An increased risk of cardiovascular events was also appreciated in a smaller open-label study comparing GH-replaced patients with a history of acromegaly to GH replaced patients with a history of a non-functioning pituitary adenoma [21].…”

Section: Discussionmentioning

confidence: 99%

Effect of growth hormone treatment on diastolic function in patients who have developed growth hormone deficiency after definitive treatment of acromegaly

Fazeli

Teoh

Lam

et al. 2016

Growth Hormone & IGF Research

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Objective Although growth hormone (GH) replacement is prescribed for patients with hypopituitarism due to many etiologies, it is not routinely prescribed for patients with GH deficiency (GHD) after cure of acromegaly (acroGHD). This study was designed to investigate the effect of GH replacement on cardiac parameters in acroGHD. Design We prospectively evaluated for 12 months 23 patients with acroGHD: 15 subjects on GH replacement and eight subjects not on GH replacement. Main outcome measures included LV mass corrected for body surface area (LVM/BSA) and measures of diastolic dysfunction (E/A ratio and deceleration time), as assessed by echocardiography. Results After 12 months of follow-up, there were no differences between the GH-treated group and the untreated group in LVM/BSA (GH: 74.4 ± 22.5g/m2 vs untreated: 72.9 ± 21.3g/m2, p=0.89), E/A ratio (GH: 1.21 ± 0.39 vs untreated: 1.08 ± 0.39, p=0.50) or deceleration time (GH: 224.5 ± 60.1ms vs untreated: 260 ± 79.8ms, p=0.32). The overall degree of diastolic function was similar between the groups with 42.9% of untreated subjects and 50% of GH-treated subjects (p=0.76) classified as having normal diastolic function at follow-up. Conclusions There were no significant differences in LVM/BSA or parameters of diastolic function in patients with a history of acromegaly treated for GHD as compared to those who were untreated. These data are reassuring with respect to cardiovascular safety with GH use after treatment for acromegaly, although further longer term study is necessary to evaluate the safety and efficacy of GH treatment in this population.

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“…Also, the acromegaly-related cardiac abnormalities could worsen after the development of GHD [101]. However, clinical studies do not fully confirm these theoretical hypotheses, as they found a BMI slightly increased [102][103][104] or, even, similar [105][106][107][108] in acroGHD compared to GHD and acromegalic populations. At the same time, while one work reported that acroGHD patients were more hypertensive, dyslipidemic, and diabetic than GHD subjects [109], other Authors pointed out a comparable prevalence of glucose abnormalities and dyslipidemia, as well as a similar amount of body fat and lean mass between acroGHD and refcerebrovascular [5, [82][83][84][85][86][87].…”

Section: B Ghd After Treatment Of Acromegaly (Acroghd)mentioning

confidence: 99%

Impact of adult growth hormone deficiency on metabolic profile and cardiovascular risk [Review]

et al. 2015

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Abstract. Adult growth hormone deficiency (GHD) is a well defined clinical condition, which is characterized by abnormal body composition, impaired physical activity and decreased quality of life. In addition, in recent years, growing interest has been shown towards cardiovascular risks in adult patients affected by GHD. In this regard, GHD is widely known to be associated with increased mortality, likely due to the increase of risk factors, such as central obesity, impaired lipid and glucose profiles and other less-known risk factors, such as inflammatory cytokines, endothelial dysfunction and oxidative stress. However, very few papers have recently discussed this topic. In this review, the aim is to clarify this issue by discussing evidence regarding the effects of adult GHD on metabolic and cardiovascular profiles.

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Effect of long-term GH replacement therapy on cardiovascular outcomes in GH-deficient patients previously treated for acromegaly: a sub-analysis from the Dutch National Registry of Growth Hormone Treatment in Adults

Cited by 11 publications

References 41 publications

Markers of Metabolic Syndrome in Patients with Pituitary Adenoma: A Case Series of 303 Patients

Markers of Metabolic Syndrome in Patients with Pituitary Adenoma: A Case Series of 303 Patients

Effect of growth hormone treatment on diastolic function in patients who have developed growth hormone deficiency after definitive treatment of acromegaly

Impact of adult growth hormone deficiency on metabolic profile and cardiovascular risk [Review]

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