Metabolic, cardiovascular, and cerebrovascular outcomes in growth hormone-deficient subjects with previous cushing's disease or non-functioning pituitary adenoma.

Abstract

CONTEXT:

Previous exposure to hypercortisolism due to Cushing's disease (CD) may adversely affect long-term metabolic and cardiovascular outcomes. In particular, metabolic and cardiovascular outcomes of patients with previous CD who require GH replacement have not been fully established.

OBJECTIVE:

The aim of the study was to compare the prevalence and incidence of metabolic syndrome (Adult Treatment Panel III criteria), diabetes mellitus, cardiovascular disease, and cerebrovascular disease in GH-treated subjects with previous CD with GH-treated subjects with previous nonfunctioning pituitary adenoma (NFPA).

DESIGN:

We conducted post hoc analysis of the observational Hypopituitary Control and Complications Study conducted at 362 international centers (1995-2006).

SUBJECTS:

We studied adult-onset GH-deficient subjects with previous CD (n = 160) or NFPA (n = 879). All subjects received GH replacement therapy and were GH naive at enrollment. Multiple pituitary deficits were prevalent in both groups.

MAIN OUTCOME MEASURES:

We measured the prevalence and incidence of metabolic syndrome, diabetes mellitus, cardiovascular disease, and cerebrovascular disease at baseline and at 3 yr, standardized for age and sex differences between groups.

RESULTS:

Compared with subjects with previous NFPA, subjects with previous CD had a significantly greater 3-yr incidence of metabolic syndrome (CD, 23.4%; NFPA, 9.2%; P = 0.01), baseline (CD, 6.3%; NFPA, 2.2%; P < 0.01) and 3-yr (CD, 7.6%; NFPA, 3.9%; P = 0.04) prevalence of cardiovascular disease, and baseline (CD, 6.4%; NFPA, 1.8%; P = 0.03) and 3-yr (CD, 10.2%; NFPA, 2.9%; P = 0.01) prevalence of cerebrovascular disease.

CONCLUSIONS:

Previous hypercortisolism may predispose GH-treated, GH-deficient subjects with prior CD to an increased risk of metabolic syndrome, cardiovascular disease, and cerebrovascular disease.

• Authors: Susan M Webb, Daojun Mo, Steven W J Lamberts, Shlomo Melmed, Francesco Cavagnini, Francesca Pecori Giraldi, Christian J Strasburger, Alan G Zimmermann, Whitney W Woodmansee, International HypoCCS Advisory Board
• Journal: The Journal of clinical endocrinology and metabolism (J Clin Endocrinol Metab) Vol. 95 Issue 2 Pg. 630-8 (Feb 2010) ISSN: 1945-7197 [Electronic] United States
• PMID: 20022992 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Human Growth Hormone

Topics

• Adenoma (complications)
• Adult
• Aged
• Cardiovascular Diseases (epidemiology)
• Cerebrovascular Disorders (epidemiology)
• Female
• Human Growth Hormone (deficiency)
• Humans
• Male
• Metabolic Syndrome (epidemiology)
• Middle Aged
• Pituitary ACTH Hypersecretion (complications)
• Pituitary Neoplasms (complications)
• Prevalence