Endocrine Abstracts

Introduction: Hypopituitary patients receiving conventional hormone substitution, but without GH replacement, have an increased mortality from cardiovascular diseases. Inadequate hormone replacement is a possible cause of this increased mortality. GH deficiency in adult patients has been associated with several cardiovascular risk factors, including hyperlipidemia, increased abdominal adiposity, and impaired insulin sensitivity.

Aim of the study: The aim of the study is evaluation of patients with GH deficiency with no clinical signs of cardiovascular diseases in the course of multihormonal hypopituitarism with special attention paid to occurrence of metabolic syndrome markers.

Material and methods: The study included 16 patients (12-M and 4-F), from 21 to 59 years (X=39) with multihormonal hypopituitarism which lasted from 1 to 29 years (x=11.15) and after surgical treatment of a tumour in the hypothalamic-hypophyseal region; patients with acromegaly and Cushing’s disease were excluded from the study. In all the studied patients basic constituents of metabolic syndrome were evaluated: body mass index (BMI), waist-hip ratio (WHR), arterial pressure, insulin resistance ratios, HOMA–IR and QUICKI, lipidogram, fibrinogen, homocysteine and echocardiography. The control group consisted of 12 healthy individuals.

Results: Hypopituitary patients had an obesity value (P=0.0063), independent of sex and age, with a higher WHR (P<0.0001). Mixed hyperlipidemia was found in 86% of the studied patients, a higher low density lipoprotein cholesterol (P=0.00293), and triglyceridemia (P=0.003). Serum homocysteine was significantly higher in patients than in controls (P=0.02). Furthermore, the patients had a significantly increased left atrium size (P=0.05).

Conclusions: Hypopituitary patients exhibit increased values of the basic markers of metabolic syndrome and an increased prevalence of cardiovascular risk factors.

Summary: In patients with hypopiyuitary, it is necessary to apply simultaneous replacement treatment with regard to all hormonal deficiencies, including GH. Close monitoring for premature development of metabolic syndrome risk factors is important, especially in the young.