Hypopituitary Females Have a High Incidence of Cardiovascular Morbidity and an Increased Prevalence of Cardiovascular Risk Factors1
Birgitta Bülow,
Lars Hagmar,
Jan Eskilsson and
Eva Marie Erfurth
Departments of Diabetology and Endocrinology (B.B., E.M.E.),
Occupational and Environmental Medicine (L.H.) and Cardiology (J.E.),
University Hospital, S-221 85 Lund, Sweden
Address all correspondence and requests for reprints to: Dr. Birgitta Bülow, Department of Diabetology and Endocrinology, University Hospital, S-221 85 Lund, Sweden.
We recently reported that female patients with hypopituitarism
receivingcontrolled thyroid and steroid hormone substitution, but
withoutGH replacement, had a more than 2-fold increase in
cardiovascularmortality compared to the general population. In the
presentstudy we investigated the incidence of cardiovascular disease
aswell as the prevalence of cardiovascular risk factors in 33females
with hypopituitarism for 6–46 yr (median, 18)compared to those in 33
control subjects recruited from thegeneral population in the same
geographical area and matchedfor sex, age, smoking habits, educational
level, and residencelocation. The patients were with a very high
probability GHdeficient, as 29 had subnormal serum insulin-like growth
factorI levels, and the other 4 were GH deficient, as assessed byan
insulin tolerance test.
The incidence of cardiovascular disease was significantly higheramong
the hypopituitary patients (incidence ratio, 3.7; 95%confidence
interval, 1.2–11.3), and the consumption ofcardioactive drugs was
also significantly higher (P = 0.002).
Hypopituitarypatients had a lower degree of physical exercise during
theirspare time (P = 0.02), a higher waist/hip
ratio (P = 0.01),lower high density lipoprotein
cholesterol (P = 0.002), andhigher low
density/high density lipoprotein ratio (P = 0.009).
Furthermore,the patients had a significantly increased left atrium
size(P = 0.05), but no difference was observed for
other cardiacmeasures. In the patients, serum insulin-like growth
factorI levels significantly correlated with left ventricular mass
index(r = 0.48; P = 0.006), suggesting that
GH has a strong impacton cardiac size. More episodes of bradycardia
(P = 0.05), butno increased occurrence of
extrasystolies, were encounteredin the patients during 24-h continuous
electrocardiogram monitoring.Carotid artery intima-media thickness and
plaque numbers didnot differ between patients and controls.
In conclusion, hypopituitary females exhibit an increased incidenceof
cardiovascular disease, higher cardioactive drug consumption,and an
increased prevalence of cardiovascular risk factors.The increased
cardiovascular morbidity could not be ascribedto inadequate estrogen
or thyroid hormone treatment, and unsubstitutedGH deficiency is
probably an important contributing factor.
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