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Metabolic changes and vascular risk factors in hypopituitarism
D G Johnston1, S A Beshyah, V Markussis
1Unit of Metabolic Medicine, St. Mary's Hospital Medical School, London, UK.
Insights
Adults with hypopituitarism face increased vascular disease mortality. Growth hormone (GH) therapy may improve cholesterol and potentially reduce this risk, but further trials are needed to confirm GH
Area of Science:
- Endocrinology
- Cardiovascular Medicine
- Metabolic Disorders
Background:
- Adults with hypopituitarism experience premature death, primarily due to vascular disease.
- Evidence suggests early ischemic changes in hypopituitary adults, including myocardial diastolic dysfunction and peripheral arterial disease.
Purpose of the Study:
- To investigate vascular disease and associated risk factors in adults with hypopituitarism.
- To explore the potential role of growth hormone (GH) deficiency in these vascular complications.
- To assess the impact of GH therapy on vascular risk factors.
Main Methods:
- Echocardiography to assess myocardial diastolic function.
- Ultrasonography to detect peripheral arterial disease.
- Examination of vascular risk factors, including glucose tolerance, diabetes, and lipid profiles.
Main Results:
- Abnormalities in myocardial diastolic function and peripheral arterial disease were observed.
- Impaired glucose tolerance, unrecognized diabetes, and elevated total cholesterol levels (especially in women) are common.
- Prolonged GH therapy decreased fasting total cholesterol without adverse effects on glucose homeostasis.
Conclusions:
- Hypopituitarism is associated with significant vascular disease and risk factor abnormalities.
- The role of GH deficiency in these complications requires further investigation.
- Long-term GH therapy trials are essential to define the impact of GH on the excess vascular risk in hypopituitarism.
Abstract:
Adults with hypopituitarism die prematurely, and the excess mortality is from vascular disease. On echocardiography we have demonstrated abnormalities of myocardial diastolic function in hypopituitary adults, indicating possible early ischaemic change. Peripheral arterial disease is evident on ultrasonography. Vascular risk factors have also been examined. Impaired glucose tolerance and unrecognized diabetes are common in hypopituitary adults. Total cholesterol levels are elevated, particularly in hypopituitary women. The role of growth hormone (GH) deficiency in the vascular disease and in the vascular-risk-factor abnormalities is unknown at present. Prolonged GH therapy causes a decrease in the levels of fasting total cholesterol, without any adverse effects on glucose homeostasis. GH therapy trials in adults will clarify the role of GH in the excess vascular risk of hypopituitarism. Prolonged GH therapy will be necessary for the vascular effects to be defined.