Hypopituitarism and atherosclerosis

Abstract

In the last decade, retrospective cohort data has provided evidence of premature atherosclerosis in patients with hypopituitarism which may account for the recently observed increased death rate from vascular events in these patients. The exact mechanism(s) for such propensity to atherosclerotic vascular disease is not yet completely clear. It is possible that hormonal factors may be the initiating mechanisms with subsequent secondary metabolic abnormalities acting as risk factors for development of atherosclerosis. This seems to be more evident in female hypopituitary patients compared with their male counterparts. Female patients have higher frequency and more pronounced abnormalities of various risk factors as well as surrogate markers of early vascular disease. This may explain why morbidity and mortality in women is in excess of men in retrospective epidemiological studies. Addressing abnormal hormonal factors, especially in females, is a primary objective in managing these patients both in the clinical arena as well as in trials designed to reduce the risk of atherosclerotic vascular disease in these patients. While short-term growth hormone treatment may ameliorate some of the vascular risk factors and improve endothelial function, it remains to be shown whether this translates into long-term reduction in morbidity and mortality from vascular, especially cerebrovascular, disease.

Hormonal and Chemical Regulation of Paraoxonases in Mice

“…Pons protect LDL and HDL from oxidation, thus preventing the development of atherosclerosis and other cardiovascular diseases (Aviram and Rosenblat, 2005). Adult patients with growth hormone deficiency are predisposed to premature atherosclerosis and other cardiovascular diseases (Twickler et al, 2000;Elhadd et al, 2001). Growth hormone replacement in GH-deficient adult patients improves their LDL-cholesterol abnormalities (Twickler et al, 2000;Abdul Shakoor and Shalet, 2003).…”

Hemostatic abnormalities in endocrine and metabolic disorders

“…A very small number of case-control studies suggested the presence of a mild to moderate prothrombotic state in adult patients with GH deficiency, which could partly contribute to the increased risk for arterial and venous thrombosis seen in hypopituitarism (88)(89)(90)(91). Increased circulating levels of VWF, thrombomodulin, and some endothelial adhesion molecules (such as intercellular adhesion molecule-1 and E-selectin) were observed by Elhadd et al in 52 GH-deficient adults (91).…”

Prothrombin G20210A Mutation, Hypogonadotropic Hypogonadism, and Generalized Vitiligo-Related Ischemic Stroke in a Young Adult

“…Endocrine abnormal-ities, including gonadotropin deficiencies, have also been demonstrated in recent studies to contribute to ischemic stroke (Bondanelli et al, 2006). There are a few published reports concerning hypogonadism associated with atherosclerosis in young adults (Elhadd, Abdu, & Clayton, 2001;Erfurth et al, 2002).…”