Hypopituitary females have a high incidence of cardiovascular morbidity and an increased prevalence of cardiovascular risk factors

We recently reported that female patients with hypopituitarism receiving co ntrolled thyroid and steroid hormone substitution, but without GH replaceme nt, had a more than 2-fold increase in cardiovascular mortality compared to the general population In the present study we investigated the incidence of cardiovascular disease as well as the prevalence of cardiovascular risk factors in 33 females with hypopituitarism for 6-46 yr (median, 18) compare d to those in 33 control subjects recruited from the general population in the same geographical area and matched for sex, age, smoking habits, educat ional level, and residence location. The patients were with a very high pro bability GH deficient, as 29 had subnormal serum insulin-like growth factor I levels, and the other 4 were GH deficient, as assessed by an insulin tol erance test. The incidence of cardiovascular disease was significantly higher among the hypopituitary patients (incidence ratio, 3.7; 95% confidence interval 1.2-1 1.3), and the consumption of cardioactive drugs was also significantly high er (P = 0.002). Hypopituitary patients had a loner degree of physical exerc ise during their spare time (P = 0.02), a higher waist/hip ratio (P = 0.01) lower high density lipoprotein cholesterol (P = 0.002), and higher low den sity/high density Lipoprotein ratio (P = 0.009). Furthermore, the patients had a significantly increased left atrium size (P = 0.05), but no differenc e was observed for other cardiac measures. In the patients, serum insulin-l ike growth factor I levels significantly correlated with left ventricular m ass index (r = 0.48; P = 0.006), suggesting that GH has a strong impact on cardiac size. More episodes of bradycardia (P = 0.05), but no increased occ urrence of extrasystolies, were encountered in the patients during 24-h con tinuous electrocardiogram monitoring. Carotid artery intima-media thickness and plaque numbers did not differ between patients and controls. In conclusion hypopituitary females exhibit an increased incidence of cardi ovascular disease, higher cardioactive drug consumption, and an increased p revalence of cardiovascular risk factors. The increased cardiovascular morb idity could not be ascribed to inadequate estrogen or thyroid hormone treat ment, and unsubstituted GH deficiency is probably an important contributing factor.