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Submitted on March 8, 2006
Accepted on July 27, 2006
Departments of Endocrinology, Sahlgrenska Academy at Gothenburg's University, Gothenburg, Sweden, St Bartholomew's Hospital, Queen Mary University of London, UK, KIGS/KIMS/ACROSTUDY Medical Outcomes, Endocrine Care, Pfizer, Sollentuna, Sweden, Department of Pharmacy, Uppsala University, Uppsala, Sweden
* To whom correspondence should be addressed. E-mail: helena.filipsson{at}telia.com.
Background Hypopituitary patients with untreated growth hormone deficiency and patients on inappropriately high doses of glucocorticoid (GC) share certain clinical features.
Objective To examine the influence of GC substitution on clinical characteristics in hypopituitary patients before and after GH replacement therapy.
Method 2424 hypopituitary patients within the KIMS database were grouped according to ACTH status. Comparisons were performed between subjects on hydrocortisone (HC) (n = 1186), cortisone acetate (CA) (n = 487), prednisolone/dexamethasone (PD) (n = 52) and ACTH-sufficient patients (AS) (n = 717) before and after 1 yr of GH treatment in terms of BMI, waist and hip circumference, blood pressure, glucose, 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 PD 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, BMI, triglycerides, LDL- and total cholesterol levels. Subjects with HCeq doses <20 mg/day (n = 328) at baseline did not differ from AS in metabolic endpoints. The 1-year 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 
20 mg/day in adults with hypopituitarism are associated with an unfavourable metabolic profile. CA replacement may have metabolic advantages compared with other GC.
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