This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Filipsson, H. Articles by Johannsson, G. Search for Related Content PubMed PubMed Citation Articles by Filipsson, H. Articles by Johannsson, G. Related Collections Adrenal and Hypertension Neuroendocrinology and Pituitary Cardiovascular Endocrinology

The Impact of Glucocorticoid Replacement Regimens on Metabolic Outcome and Comorbidity in Hypopituitary Patients

Department of Endocrinology (H.F., G.J.), Sahlgrenska Academy at Gothenburg’s University, SE-413 45 Gothenburg, Sweden; St. Bartholomew’s Hospital (J.P.M.), Queen Mary University of London, London EC1A 7BE, United Kingdom; KIGS/KIMS/ACROSTUDY Medical Outcomes (M.K.-H., A.M.), Endocrine Care, Pfizer, SE-191 90 Sollentuna, Sweden; and Department of Pharmacy (M.K.-H.), Uppsala University, Uppsala, Sweden

Address all correspondence and requests for reprints to: Helena Filipsson, Department of Endocrinology, Gröna Stråket 8, Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden. E-mail: helena.filipsson{at}telia.com.

Background: Hypopituitary patients with untreated GH deficiency and patients on inappropriately high doses of glucocorticoid (GC) share certain clinical features.

Objective: The aim of the study was to examine the influence of GC substitution on clinical characteristics in hypopituitary patients before and after GH replacement therapy.

Method: A total of 2424 hypopituitary patients within the KIMS (Pfizer International Metabolic Database) were grouped according to ACTH status. Comparisons were performed between subjects on hydrocortisone (HC) (n = 1186), cortisone acetate (CA) (n = 487), and prednisolone/dexamethasone (n = 52), and ACTH-sufficient patients (AS) (n = 717) before and after 1 yr of GH treatment in terms of body mass index, waist and hip circumference, blood pressure, glucose, glycosylated hemoglobin (HbA1c), serum lipids, IGF-I, and comorbidity. Hydrocortisone equivalent (HCeq) doses were calculated, and measurements were adjusted for sex and age.

Results: At baseline, the HC group had increased total cholesterol, triglycerides, waist circumference, and HbA1c, and the prednisolone/dexamethasone group had increased waist/hip ratio as compared with AS. After HCeq dose adjustment, the HC group retained higher HbA1c than the CA group. GC-treated patients showed a dose-related increase in serum IGF-I, body mass index, triglycerides, low-density lipoprotein cholesterol and total cholesterol levels. Subjects with HCeq doses less than 20 mg/d (n = 328) at baseline did not differ from AS in metabolic endpoints. The 1-yr metabolic response to GH was similar in all GC groups and dose categories. All new cases of diabetes (n = 12), stroke (n = 8), and myocardial infarction (n = 3) during GH treatment occurred in GC-treated subjects.

Conclusion: HCeq doses of at least 20 mg/d in adults with hypopituitarism are associated with an unfavorable metabolic profile. CA replacement may have metabolic advantages compared with other GCs.

This article has been cited by other articles:

				J. Verhelst and R. Abs Cardiovascular risk factors in hypopituitary GH-deficient adults Eur. J. Endocrinol., November 1, 2009; 161(S1): S41 - S49. [Abstract] [Full Text] [PDF]

				H. Filipsson and G. Johannsson GH replacement in adults: interactions with other pituitary hormone deficiencies and replacement therapies Eur. J. Endocrinol., November 1, 2009; 161(S1): S85 - S95. [Abstract] [Full Text] [PDF]

				M. Sherlock, R. C. Reulen, A. A. Alonso, J. Ayuk, R. N. Clayton, M. C. Sheppard, M. M. Hawkins, A. S. Bates, and P. M. Stewart ACTH Deficiency, Higher Doses of Hydrocortisone Replacement, and Radiotherapy Are Independent Predictors of Mortality in Patients with Acromegaly J. Clin. Endocrinol. Metab., November 1, 2009; 94(11): 4216 - 4223. [Abstract] [Full Text] [PDF]

				G. Johannsson, R. Bergthorsdottir, A. G Nilsson, H. Lennernas, T. Hedner, and S. Skrtic Improving glucocorticoid replacement therapy using a novel modified-release hydrocortisone tablet: a pharmacokinetic study Eur. J. Endocrinol., July 1, 2009; 161(1): 119 - 130. [Abstract] [Full Text] [PDF]

				M. Debono, R. J Ross, and J. Newell-Price Inadequacies of glucocorticoid replacement and improvements by physiological circadian therapy Eur. J. Endocrinol., May 1, 2009; 160(5): 719 - 729. [Abstract] [Full Text] [PDF]

				A. N. Paisley, S. V. Rowles, D. Brandon, and P. J. Trainer A Subnormal Peak Cortisol Response to Stimulation Testing Does Not Predict a Subnormal Cortisol Production Rate J. Clin. Endocrinol. Metab., May 1, 2009; 94(5): 1757 - 1760. [Abstract] [Full Text] [PDF]

				S. M. Webb, C. J. Strasburger, D. Mo, M. L. Hartman, S. Melmed, H. Jung, W. F. Blum, A. F. Attanasio, and on behalf of the HypoCCS International Advisory Bo Changing Patterns of the Adult Growth Hormone Deficiency Diagnosis Documented in a Decade-Long Global Surveillance Database J. Clin. Endocrinol. Metab., February 1, 2009; 94(2): 392 - 399. [Abstract] [Full Text] [PDF]

				M. M Erichsen, K. Lovas, K. J Fougner, J. Svartberg, E. R Hauge, J. Bollerslev, J. P Berg, B. Mella, and E. S Husebye Normal overall mortality rate in Addison's disease, but young patients are at risk of premature death Eur. J. Endocrinol., February 1, 2009; 160(2): 233 - 237. [Abstract] [Full Text] [PDF]

				H. Falhammar, H. Filipsson, G. Holmdahl, P.-O. Janson, A. Nordenskjold, K. Hagenfeldt, and M. Thoren Fractures and Bone Mineral Density in Adult Women with 21-Hydroxylase Deficiency J. Clin. Endocrinol. Metab., December 1, 2007; 92(12): 4643 - 4649. [Abstract] [Full Text] [PDF]

				B. R Walker Glucocorticoids and Cardiovascular Disease Eur. J. Endocrinol., November 1, 2007; 157(5): 545 - 559. [Abstract] [Full Text] [PDF]

				A. A van der Klaauw, N. R Biermasz, E. J M Feskens, M. B Bos, J. W A Smit, F. Roelfsema, E. P M Corssmit, H. Pijl, J. A Romijn, and A. M Pereira The prevalence of the metabolic syndrome is increased in patients with GH deficiency, irrespective of long-term substitution with recombinant human GH Eur. J. Endocrinol., April 1, 2007; 156(4): 455 - 462. [Abstract] [Full Text] [PDF]

				C. Parkinson, P. Burman, M. Messig, and P. J. Trainer Gender, Body Weight, Disease Activity, and Previous Radiotherapy Influence the Response to Pegvisomant J. Clin. Endocrinol. Metab., January 1, 2007; 92(1): 190 - 195. [Abstract] [Full Text] [PDF]