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The Journal of Clinical Endocrinology & Metabolism Vol. 89, No. 7 3306-3312
Copyright © 2004 by The Endocrine Society

Malignant Disease and Cardiovascular Morbidity in Hypopituitary Adults with or without Growth Hormone Replacement Therapy

J. Svensson, B.-Å. Bengtsson, T. Rosén, A. Odén and G. Johannsson

Research Centre for Endocrinology and Metabolism (J.S., B.-Å.B., T.R., G.J.), Sahlgrenska University Hospital, SE-413 45 Göteborg, Sweden; and consulting statistician (A.O.), SE-44292 Romelanda, Sweden

Address all correspondence and requests for reprints to: Johan Svensson, M.D., Research Centre for Endocrinology and Metabolism, Gröna Stråket 8, Sahlgrenska University Hospital, SE-413 45 Göteborg, Sweden. E-mail: Johan.Svensson{at}medic.gu.se.

A retrospective comparison was performed between 1411 hypopituitary adults without GH replacement [mean age, 56.9 (SD 18.6) yr] and the normal population in terms of fatal and nonfatal morbidity. A similar prospective comparison was then made in 289 hypopituitary patients on long-term GH replacement [mean age, 47.6 (SD 14.8) yr; mean duration of GH treatment, 60 months].

In the 1411 hypopituitary patients without GH replacement, overall mortality (P < 0.001), and the rates of myocardial infarctions (P < 0.01), cerebrovascular events (P < 0.001), and malignancies (P < 0.001) were increased compared with the normal population. Colorectal cancer was the most common malignancy in this cohort (P < 0.001 vs. the background population). In the 289 hypopituitary patients on GH replacement, overall mortality and the rate of malignancies were similar to the normal population. In the hypopituitary adults on GH therapy, the rate of myocardial infarctions was lower than that in the background population (P < 0.05), and there was a tendency toward an increased rate of cerebrovascular events.

In conclusion, overall mortality and the rate of myocardial infarctions were increased in hypopituitary patients without GH replacement. An increased rate of malignancies was observed in the hypopituitary adults without GH therapy, with a predominance of colorectal cancer. GH replacement appeared to provide protection from myocardial infarctions. The rate of cerebrovascular events tended to be increased also in hypopituitary adults on GH therapy.

This study was supported by the chair of Göteborg and the Novo Nordisk Foundation.

Results of this work were presented in part at the 85th Annual Meeting of The Endocrine Society, Philadelphia, Pennsylvania, June 2003.

Abbreviation: IGFBP-3, IGF-binding protein-3.




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