The Role of Thyroid Disorders, Obesity, Diabetes Mellitus and Estrogen Exposure as Potential Modifiers for Pulmonary Hypertension

Abstract

Pulmonary hypertension (PH) is a progressive disorder characterized by a chronic in-crease in pulmonary arterial pressure, frequently resulting in right-sided heart failure and potentially death. Co-existing medical conditions are important factors in PH, since they not only result in the genesis of the disorder, but may also contribute to its progression. Various studies have assessed the impact of thyroid disorders and other endocrine conditions (namely estrogen exposure, obesity, and diabetes mellitus) on the progression of PH. The complex interactions that hormones may have with the cardiovascular system and pulmonary vascular bed can create several pathogenetic routes that could explain the effects of endocrine disorders on PH development and evolution. The aim of this review is to summarize current knowledge on the role of concomitant thyroid disorders, obesity, diabetes mellitus, and estrogen exposure as potential modifiers for PH, and especially for pulmonary arterial hypertension, and to discuss possible pathogenetic routes linking them with PH. This information could be valuable for practicing clinicians so as to better evaluate and/or treat concomitant endocrine conditions in the PH population.

Pulmonary Hypertension and Hypothyroidism—Still an Important Clinical Coincidence in Paediatric Population, an Endocrinologist’s Point of View

“…Pulmonary hypertension (PH) is a chronic and often progressive disease that not uncommonly may be caused or influenced by other comorbidities [ 1 ]. The prevalence of autoimmune thyroid diseases (AITDs) in patients with PH has been estimated as high as 24% [ 1 , 2 , 3 , 4 ] and even higher in studies regarding smaller cohorts of patients [ 5 , 6 ].…”

“…Pulmonary hypertension (PH) is a chronic and often progressive disease that not uncommonly may be caused or influenced by other comorbidities [ 1 ]. The prevalence of autoimmune thyroid diseases (AITDs) in patients with PH has been estimated as high as 24% [ 1 , 2 , 3 , 4 ] and even higher in studies regarding smaller cohorts of patients [ 5 , 6 ]. Pulmonary arterial hypertension (PAH), with an estimated incidence of 4–10 cases per million children per year [ 7 , 8 ], is described as a PH subgroup with the highest prevalence of AITDs [ 1 ].…”

The Relationship between Pulmonary Artery Pressure and Mortality in Type 2 Diabetes: A Fremantle Diabetes Study Phase II and National Echocardiographic Database of Australia Data Linkage Study

“…In people with diabetes, the risk of PH is increased [17,18] and the available evidence suggests that it carries a particularly poor prognosis [19,20]. Whether the presence of an eRVSP >30 mmHg, which was present in approximately one-third of community-based individuals with type 2 diabetes who had undergone echocardiography as part of routine clinical care [21], has the same prognostic significance as in the general population is unknown.…”

Pulmonary Hypertension: Current Diagnosis, Approach and Treatment at the Dawn of the New European Guidelines

“…This suggests a microvascular systemic involvement in PAH and might assist the clinician to earlier identify PAH in this setting. The second review assesses the direct or indirect role of thyroid diseases, obesity, diabetes mellitus, and estrogens in PH and PAH [ 11 ]. Importantly, this review comments on potential pregnancy in PAH.…”

“…Importantly, this review comments on potential pregnancy in PAH. These comments should be viewed in conjunction with the recommendations for women of childbearing potential given in the European Guidelines [ 1 , 11 ].…”