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Heart in pituitary diseases
1IIIrd Department of Internal Medicine, Charles University, 1st School of Medicine, Prague, Czechoslovakia.
Insights
Growth hormone (GH) overproduction causes acromegaly, leading to heart problems like hypertension and cardiac hypertrophy. Early treatment of acromegaly can reverse these cardiovascular effects.
Area of Science:
- Endocrinology
- Cardiology
- Metabolic Disorders
Background:
- Growth hormone (GH) is the only pituitary hormone directly impacting cardiac function and metabolism.
- Chronic GH overproduction in adults results in acromegaly, characterized by hypertension and cardiac hypertrophy.
- The "acromegalic heart" is a distinct clinical entity requiring thorough investigation.
Purpose of the Study:
- To investigate the cardiovascular manifestations in a cohort of acromegaly patients.
- To elucidate the direct role of GH in the development of cardiac hypertrophy and hypertension.
- To assess the reversibility of cardiac and hypertensive changes after GH normalization.
Main Methods:
- Clinical research on a unique group of 78 acromegaly patients.
- Long-term follow-up of patients with acromegaly.
- Analysis of clinical findings and existing experimental data in the literature.
Main Results:
- Cardiac hypertrophy in acromegaly is directly caused by GH's effect on the myocardium.
- Hypertension, present in 50% of patients, is volume-related and adds to left ventricular hypertrophy.
- Cardiac hypertrophy and hypertension show partial reversibility upon elimination of GH overproduction.
Conclusions:
- Early and aggressive treatment of acromegaly is crucial for managing cardiovascular complications.
- GH directly contributes to cardiac hypertrophy in acromegaly.
- Intervention can lead to significant, though not always complete, reversal of cardiac and hypertensive abnormalities.
Abstract:
Of hormones secreted by the pituitary, a direct effect on cardiac metabolism and function is exerted only by growth hormone (GH). Its chronic overproduction in adulthood leads to acromegaly. The main cardiovascular manifestations of acromegaly are hypertension and cardiac hypertrophy. The paper summarizes the results of clinical research into the "acromegalic heart" in an internationally unique group of 78 patients with acromegaly on long-term follow-up. Both clinical findings and experimental data available in the literature indicate that cardiac hypertrophy is due to a direct effect of GH on the myocardium. Hypertension occurs in 50% of patients, has the nature of volume hypertension and exerts only an additive effect on the development of left ventricular hypertrophy. Once GH overproduction has been eliminated, cardiac hypertrophy and hypertension can be reversed to a certain stage, a finding highlighting the necessity of instituting treatment of acromegaly as early and as vigorous as possible.