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Published on: October 15, 2010
Endothelial function and coagulant factors in growth hormone-treated hypopituitary adults receiving desmopressin
1Department of Medicine, University Hospital of Wales, Cardiff CF14 4XN, United Kingdom. jamie.smith@virgin.net
Insights
Adults with hypopituitarism show elevated clotting factors, indicating a prothrombotic risk despite intact vasodilation. Chronic intranasal desmopressin acetate (DDAVP) therapy did not alter these hemostatic markers or endothelial function.
Area of Science:
- Endocrinology
- Cardiovascular Medicine
- Hematology
Background:
- Adult hypopituitarism is associated with increased cardiovascular risk, potentially linked to growth hormone (GH) deficiency, other hormonal deficits, or hormone replacement therapy.
- Desmopressin acetate (DDAVP), administered parenterally, enhances hemostasis by boosting procoagulant factors.
- The impact of chronic intranasal DDAVP on hemostatic markers and endothelial function in GH-treated hypopituitary adults with vasopressin deficiency is not well understood.
Purpose of the Study:
- To investigate the effects of chronic intranasal DDAVP therapy on clotting factors and endothelial function in GH-treated hypopituitary adults.
- To compare hemostatic markers and endothelial function between DDAVP-treated hypopituitary subjects, vasopressin-sufficient hypopituitary subjects, and healthy controls.
Main Methods:
- A study involving 30 GH-treated hypopituitary subjects (15 receiving intranasal DDAVP, 15 vasopressin-sufficient) and 15 healthy controls.
- Measurement of plasma fibrinogen, factor VIII, and von Willebrand factor antigen.
- Assessment of endothelial function via flow-mediated dilation of the brachial artery.
Main Results:
- Hypopituitary subjects (both groups) exhibited higher concentrations of fibrinogen, factor VIII, and von Willebrand factor antigen compared to healthy controls.
- No significant differences in clotting factors were observed between the DDAVP-treated and vasopressin-sufficient hypopituitary groups.
- Flow-mediated dilation was comparable across all three groups, indicating intact endothelium-dependent vasodilation.
Conclusions:
- GH-treated hypopituitary adults, even with intact vasodilation, present with elevated hemostatic markers, suggesting a persistent prothrombotic tendency.
- Chronic intranasal DDAVP therapy does not appear to modify the proatherogenic profile in hypopituitary adults with vasopressin deficiency.
- Further research is needed to fully elucidate the cardiovascular risks in hypopituitary patients and the role of various hormonal deficiencies and replacement strategies.
Abstract:
Although GH deficiency may underlie the increased cardiovascular risk in adult hypopituitarism, other coexisting hormonal deficiencies and/or unphysiological hormone replacement may contribute. L-Deamino-8-D-arginine (DDAVP), when administered parenterally, potentiates hemostasis by increasing plasma procoagulant factors. We investigated whether chronic intranasal DDAVP therapy influences clotting factors (plasma fibrinogen, factor VIII, and von Willebrand factor antigen) and endothelial function (flow-mediated dilation of the brachial artery) in 30 GH-treated hypopituitary subjects, including both DDAVP-treated subjects (group A) (mean age, 46 +/- 11 yr) and vasopressin-sufficient subjects (group B) (mean age, 47 +/- 16 yr). Fifteen healthy controls (group C) (mean age, 48 +/- 12 yr) were also studied. All hypopituitary patients were receiving stable GH replacement (median duration, 19 months). Comparing the three groups, concentrations of fibrinogen (mean +/- SD) (A, 3.3 +/- 1.0 g/liter vs. B, 3.5 +/- 0.9 vs. C, 2.6 +/- 0.8, P < 0.05), factor VIII (A, 130% +/- 30% vs. B, 128% +/- 30% vs. C, 104% +/- 35%, P < 0.05) and von Willebrand factor antigen (A, 124% +/- 35% vs. B, 134% +/- 45% vs. C, 93% +/- 36%, P < 0.05) were higher in hypopituitary subjects, compared with controls. However, there were no differences in clotting factors between groups A and B. Flow-mediated dilation did not differ significantly between the two hypopituitary groups (A, 5.9% +/- 2.0% vs. B, 4.7% +/- 1.6%) and was similar to that in the control group (C, 5.7% +/- 2.1%). In conclusion, although endothelium-dependent vasodilation is intact in GH-treated hypopituitary adults, elevated concentrations of hemostatic markers suggest the persistence of a prothrombotic tendency and endothelial dysfunction. Intranasal DDAVP does not appear to influence this proatherogenic profile in hypopituitary adults with vasopressin deficiency.
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