Nonfatal stroke, cardiac disease, and diabetes mellitus in hypopituitary patients on hormone replacement including growth hormone.
BACKGROUND
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.


METHODS
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.
Holmer
Helene
H
Department of Internal Medicine, Centralsjukhuset, SE-291 85, Kristianstad, Sweden.
Svensson
Johan
J
Rylander
Lars
L
Johannsson
Gudmundur
G
Rosén
Thord
T
Bengtsson
Bengt-Ake
BA
Thorén
Marja
M
Höybye
Charlotte
C
Degerblad
Marie
M
Bramnert
Margareta
M
Hägg
Erik
E
Edén Engström
Britt
B
Ekman
Bertil
B
Norrving
Bo
B
Hagmar
Lars
L
Erfurth
Eva-Marie
EM
D000328:Adult; D000368:Aged; D002316:Cardiotonic Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000453:epidemiology*; D003925:Diabetic Angiopathies / Q000453:epidemiology; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000453:epidemiology* / Q000517:prevention & control; D020249:Hormone Replacement Therapy / Q000009:adverse effects; D019382:Human Growth Hormone / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007018:Hypopituitarism / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000150:complications / Q000453:epidemiology*
D002316:Cardiotonic Agents; D019382:Human Growth Hormone