Metabolic, Cardiovascular, and Cerebrovascular Outcomes in Growth Hormone-Deficient Subjects with Previous Cushing’s Disease or Non-Functioning Pituitary Adenoma

• Published in: The journal of clinical endocrinology and metabolism Vol. 95; no. 2; pp. 630 - 638
• Main Authors: Webb, Susan M., Mo, Daojun, Lamberts, Steven W. J., Melmed, Shlomo, Cavagnini, Francesco, Pecori Giraldi, Francesca, Strasburger, Christian J., Zimmermann, Alan G., Woodmansee, Whitney W.
• Format: Journal Article
• Language: English
• Published: Bethesda, MD Oxford University Press 01.02.2010; Copyright by The Endocrine Society; Endocrine Society
• Subjects: Adenoma; Adenoma - complications; Adrenals. Adrenal axis. Renin-angiotensin system (diseases); Adrenocorticotropic hormone; Adult; Aged; Biological and medical sciences; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - epidemiology; Cerebrovascular disease; Cerebrovascular diseases; Cerebrovascular Disorders - epidemiology; Diabetes; Diabetes mellitus; Endocrinopathies; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Growth hormones; Human Growth Hormone - deficiency; Humans; Male; Medical sciences; Metabolic syndrome; Metabolic Syndrome - epidemiology; Middle Aged; Nervous system diseases; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Pituitary; Pituitary ACTH Hypersecretion - complications; Pituitary Neoplasms - complications; Prevalence; Sex differences; Tumors; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology; Endocrinopathy; Human; Obesity; Prognosis; Adrenal cortex diseases; Nutrition; Deficiency; Nutrition disorder; Cushing syndrome; Metabolic diseases; Cardiovascular disease; Hyperadrenocorticism; Metabolism; Somatotropin; Adenohypophyseal hormone; Adrenal gland diseases; Pituitary diseases; Pituitary adenoma; Endocrinology; Nutritional status
• ISSN: 0021-972X; 1945-7197; 1945-7197
• DOI: 10.1210/jc.2009-0806

Context: Previous exposure to hypercortisolism due to Cushing’s disease (CD) may adversely affect long-term metabolic and cardiovascular outcomes. In particular, metabolic and cardiovascular outcomes of patients with previous CD who require GH replacement have not been fully established. Objective: The aim of the study was to compare the prevalence and incidence of metabolic syndrome (Adult Treatment Panel III criteria), diabetes mellitus, cardiovascular disease, and cerebrovascular disease in GH-treated subjects with previous CD with GH-treated subjects with previous nonfunctioning pituitary adenoma (NFPA). Design: We conducted post hoc analysis of the observational Hypopituitary Control and Complications Study conducted at 362 international centers (1995–2006). Subjects: We studied adult-onset GH-deficient subjects with previous CD (n = 160) or NFPA (n = 879). All subjects received GH replacement therapy and were GH naive at enrollment. Multiple pituitary deficits were prevalent in both groups. Main Outcome Measures: We measured the prevalence and incidence of metabolic syndrome, diabetes mellitus, cardiovascular disease, and cerebrovascular disease at baseline and at 3 yr, standardized for age and sex differences between groups. Results: Compared with subjects with previous NFPA, subjects with previous CD had a significantly greater 3-yr incidence of metabolic syndrome (CD, 23.4%; NFPA, 9.2%; P = 0.01), baseline (CD, 6.3%; NFPA, 2.2%; P < 0.01) and 3-yr (CD, 7.6%; NFPA, 3.9%; P = 0.04) prevalence of cardiovascular disease, and baseline (CD, 6.4%; NFPA, 1.8%; P = 0.03) and 3-yr (CD, 10.2%; NFPA, 2.9%; P = 0.01) prevalence of cerebrovascular disease. Conclusions: Previous hypercortisolism may predispose GH-treated, GH-deficient subjects with prior CD to an increased risk of metabolic syndrome, cardiovascular disease, and cerebrovascular disease.