title: Reactivity to stress and psychological adjustment in adults with pituitary insufficiency.
abstract: OBJECTIVE
  Hypopituitary adults who were affected during childhood have a below-average rate of marriage, a rate of unemployment that exceeds national norms, and often indicate dissatisfaction with their life circumstances. We undertook the present study to determine the effects of short stature versus those of pituitary hormone deficiency.
  
  
  METHODS
  We compared hypopituitary adults (n = 25) with normal short adults (n = 25) who were matched for height, sex, age and socioeconomic status.
  
  
  METHODS
  In these two groups of subjects, we compared the physiological responses to a simulated social stressor, a public speaking task, and we measured the psychometric attributes that are indicators of social assertiveness and extraversion.
  
  
  RESULTS
  Before, during and after the stress of public speaking, patients with multiple pituitary hormone deficiencies (n = 20) had lower mean systolic and diastolic blood pressures than controls, while patients with isolated growth hormone deficiency (n = 5) were equivalent to controls. The reactivity to stress, assessed using delta scores based on changes in blood pressure and heart rate, was also decreased in multiple hormone deficient patients. Psychometric test results indicated that patients with multiple hormone deficiencies showed lower openness, lower assertiveness, greater neuroticism and a tendency towards less extraversion than did controls. The responses of patients with isolated GH deficiency on the psychometric tests were not statistically different from controls, but the number of subjects in this group (n = 5) was too small to draw conclusions.
  
  
  CONCLUSIONS
  The impaired cardiovascular responses to stress in patients with multiple hormone deficiencies, compared to short control subjects and to patients with GH deficiency leads us to conclude that factors other than stature and GH are responsible for these observations. The differences might be related to insufficiency of catecholamines or cortisol in the patients with multiple hormone deficiencies. These hormonal deficiencies might also account for the socially inhibited behaviour of these patients. Our results suggest that more attention needs to be directed at preparing hypopituitary patients for the challenges of adulthood. Also, these patients may be helped by more intensive efforts at hormonal replacement in adulthood.
authors.affiliation: Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill.
authors.forename: B
authors.initials: B
authors.lastname: Stabler
authors.forename: J R
authors.initials: JR
authors.lastname: Turner
authors.forename: S S
authors.initials: SS
authors.lastname: Girdler
authors.forename: K C
authors.initials: KC
authors.lastname: Light
authors.forename: L E
authors.initials: LE
authors.lastname: Underwood
mesh_terms: D000293:Adolescent; D000328:Adult; D001794:Blood Pressure / Q000502:physiology; D002395:Catecholamines / Q000378:metabolism; D005260:Female; D006130:Growth Disorders / Q000097:blood / Q000523:psychology*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D006854:Hydrocortisone / Q000172:deficiency; D007018:Hypopituitarism / Q000097:blood / Q000523:psychology*; D008297:Male; D011594:Psychometrics; D012917:Social Adjustment; D013315:Stress, Psychological / Q000097:blood / Q000523:psychology*
chemical_list: D002395:Catecholamines; D006854:Hydrocortisone