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 hypopituitaryadults 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 hypopituitarypatients 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, overallmortality (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 hypopituitarypatients on GH replacement, overall mortality and the rate ofmalignancies were similar to the normal population. In the hypopituitaryadults on GH therapy, the rate of myocardial infarctions waslower than that in the background population (P < 0.05),and there was a tendency toward an increased rate of cerebrovascularevents.
In conclusion, overall mortality and the rate of myocardialinfarctions were increased in hypopituitary patients withoutGH replacement. An increased rate of malignancies was observedin the hypopituitary adults without GH therapy, with a predominanceof colorectal cancer. GH replacement appeared to provide protectionfrom myocardial infarctions. The rate of cerebrovascular eventstended to be increased also in hypopituitary adults on GH therapy.
This study was supported by the chair of Göteborg and theNovo Nordisk Foundation.
Results of this work were presented in part at the 85th AnnualMeeting of The Endocrine Society, Philadelphia, Pennsylvania,June 2003.
Abbreviation: IGFBP-3, IGF-binding protein-3.
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