title: High prevalence of abnormal circadian blood pressure regulation and impaired glucose tolerance in adults with hypopituitarism.
abstract: Patients with hypopituitarism have an increased mortality from cardiovascular events. Reduced nocturnal blood pressure decline (non-dipping) and impaired glucose tolerance are considered as cardiovascular risk factors. To evaluate the role of these risk factors in patients with hypopituitarism we determined the 24-hour blood pressure regulation and glucose tolerance status in hypopituitary patients with and without growth hormone (GH) deficiency. Sixty-one hypopituitary subjects 5 +/- 3 years after brain surgery because of macroadenoma, 61 patients with type 2 diabetes mellitus (T2DM), and 20 healthy controls were included. Forty-four hypopituitary patients were GH deficient and 28 of these on GH treatment. Non-dipping was observed in 41 % (n = 7) of hypopituitary subjects with normal GH release, in 46 % (n = 13) of patients on GH therapy, and in 69 % (n = 11) of untreated GH deficient patients. Untreated GH deficient patients had a higher systolic night/day ratio (1.00 +/- 0.03) compared to non GH deficient (0.92 +/- 0.02; p < 0.02) and GH treated hypopituitary patients (0.93 +/- 0.01; p < 0.02). The rate of non-dipping in hypopituitarism was comparable to that in T2DM. Pathologic glucose tolerance was diagnosed in 30 % of the hypopituitary patients. The prevalence of non-dipping was independent of glucose metabolism in hypopituitary patients. All controls had normal night time blood pressure fall and glucose metabolism. The high prevalence of nocturnal non-dipping and glucose intolerance detected in this cohort might contribute to the increased cardiovascular risk of hypopituitary patients.
authors.affiliation: Department of Internal Medicine I, Rudolfstiftung Hospital, Vienna, Austria. katarzyna.krzyzanowska@wienkav.at
authors.forename: K
authors.initials: K
authors.lastname: Krzyzanowska
authors.forename: C
authors.initials: C
authors.lastname: Schnack
authors.forename: F
authors.initials: F
authors.lastname: Mittermayer
authors.forename: H P
authors.initials: HP
authors.lastname: Kopp
authors.forename: M
authors.initials: M
authors.lastname: Hofer
authors.forename: T
authors.initials: T
authors.lastname: Kann
authors.forename: G
authors.initials: G
authors.lastname: Schernthaner
mesh_terms: D000236:Adenoma / Q000150:complications / Q000628:therapy; D001794:Blood Pressure; D001932:Brain Neoplasms; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality / Q000503:physiopathology*; D002940:Circadian Rhythm / Q000502:physiology*; D015331:Cohort Studies; D005260:Female; D005947:Glucose / Q000378:metabolism*; D005951:Glucose Tolerance Test; D013006:Growth Hormone / Q000172:deficiency / Q000627:therapeutic use; D006801:Humans; D007018:Hypopituitarism / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors
chemical_list: D013006:Growth Hormone; D005947:Glucose