Endocrine Abstracts

Background and aim: Patients with GH deficiency (GHD) have increased risk of cerebrovascular events. The aim of this study was to evaluate the rate and factors associated with the occurrence of stroke, a major cause of death and disability, in adults with GHD.

Patients and methods: Data from 15,188 GHD patients treated with GH replacement therapy (GHRT) enrolled in KIMS were analyzed. Stroke incidence rates were compared to rates from the Oxford Vascular Study (Lancet_2004; 363:1925–33) by standardized incidence ratios (SIRs). Age at first radiotherapy (RT) corrected for attained age and sex, was analyzed with Poisson regression.

Results: Causes of GHD comprised pituitary adenoma 42.9%, craniopharyngioma 10.8% and idiopathic GHD 15.6%. Mean age at KIMS entry was 43.7 (range 17–75) years. Mean GH dose was 0.42 mg/day and number of patient treatment-years was 81,086. Mean age at first radiotherapy (RT) was 34.5 (range 3–72) yrs. First-ever stroke was reported in 155/7667 (M) and 123/7521 (F) patients. The crude incidence was 377 (M) and 308 (F) per 100,000 patient- years and overall SIR was 2.51 (95% CI: 2.22–2.82). SIR ranged between causes of GHD from 1.02 (0.41–2.1) in patients with Idiopathic GHD and unexposed to RT to 19.3 (11.6–30.1) in patients with GHD secondary to a malignant cranial tumor. RT was reported in 3866 patients and 146 reported a stroke (SIR: 3.96; 3.35–4.66). Rates were increased in all ages at first exposure (P<0.01), especially in younger patients (RR=2.2 (1.05–4.63) for <18 vs ≥18 years of age). Among 11,322 patients who did not receive RT, 132 cases were reported, SIR 1.78 (1.49–2.11).

Conclusion: GHD patients have a significantly increased rate of strokes with considerable variability between causes of GHD. Rates were positively associated with RT in all studied ages, with younger patients at first RT showing a higher risk.