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Nonfatal Stroke, Cardiac Disease, and Diabetes Mellitus in Hypopituitary Patients on Hormone Replacement Including Growth Hormone

Department of Internal Medicine (H.H.), Centralsjukhuset, SE-291 85, Kristianstad, Sweden; Endocrine Unit (H.H., E.-M.E.), Departments of Medicine and Neurology (B.N.), Lund University Hospital, SE-221 85 Lund, Sweden; Research Centre for Endocrinology and Metabolism (J.S., G.J., T.R., B.-A.B.), Sahlgrenska University Hospital, SE-413 45 Göteborg, Sweden; Division of Occupational and Environmental Medicine and Psychiatric Epidemiology (L.R., L.H.), Lund University, SE-221 00 Lund, Sweden; Department of Endocrinology, Metabolism and Diabetes (M.T., C.H., M.D.), Karolinska University Hospital Solna, SE-141 86 Stockholm, Sweden; Department of Endocrinology (M.B.), University Hospital, SE-205 02 Malmö, Sweden; Department of Medicine (E.H.), University Hospital, SE-901 87 Umeå, Sweden; Department of Medical Sciences (B.E.E.), Internal Medicine, Uppsala University Hospital, SE-751 85 Uppsala, Sweden; and Internal Medicine (B.E.), Department of Medicine and Care, University Hospital, SE-581 83 Linköping, Sweden

Address all correspondence and requests for reprints to: Eva-Marie Erfurth, Department of Endocrinology, Lund University Hospital, SE-221 85 Lund, Sweden. E-mail: Eva-Marie.Erfurth{at}med.lu.se.

Context: The impact of long-term GH replacement on cerebrovascular and cardiovascular diseases and diabetes mellitus in hypopituitary patients is unknown.

Objective: The incidence of nonfatal stroke and cardiac events, and prevalence of type 2 diabetes mellitus (T2D) and cardioprotective medication were compared between cohorts of GH-deficient (GHD) patients and population controls.

Design and Participants: The incidence of nonfatal stroke and cardiac events was estimated retrospectively from questionnaires in 750 GHD patients and 2314 matched population controls. A prevalence of T2D and cardioprotective medication was recorded at the distribution of questionnaires. Time since first pituitary deficiency to start of GH therapy was 4 and 2 yr, and time on GH therapy was 6 yr for GHD women and men, respectively.

Results: Lifelong incidence of nonfatal stroke was tripled in GHD women and doubled in GHD men, but a decline was seen in both genders during periods after first pituitary hormone deficiency and GHD, during which most patients had GH therapy. The lifelong incidence of nonfatal cardiac events declined in GHD men during first pituitary hormone deficiency and GHD periods. GHD women had a higher prevalence of T2D and lipid-lowering medication, whereas GHD men had a higher prevalence of antihypertensive medication.

Conclusions: The declined risks of nonfatal stroke in both genders and of nonfatal cardiac events in GHD men during periods on GH replacement may be caused by prescription of cardioprotective drugs and 6-yr GH replacement. GHD women had an increased prevalence of T2D, partly attributed to higher body mass index and lower physical activity.

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