Bülow B, Hagmar L, Eskilsson J, Erfurth E M
Department of Diabetology and Endocrinology, University Hospital, Lund, Sweden.
J Clin Endocrinol Metab. 2000 Feb;85(2):574-84. doi: 10.1210/jcem.85.2.6346.
We recently reported that female patients with hypopituitarism receiving controlled thyroid and steroid hormone substitution, but without GH replacement, 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) compared to those in 33 control subjects recruited from the general population in the same geographical area and matched for sex, age, smoking habits, educational level, and residence location. The patients were with a very high probability 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 tolerance test. The incidence of cardiovascular disease was significantly higher among the hypopituitary patients (incidence ratio, 3.7; 95% confidence interval, 1.2-11.3), and the consumption of cardioactive drugs was also significantly higher (P = 0.002). Hypopituitary patients had a lower degree of physical exercise 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 density/high density lipoprotein ratio (P = 0.009). Furthermore, the patients had a significantly increased left atrium size (P = 0.05), but no difference was observed for other cardiac measures. In the patients, serum insulin-like growth factor I levels significantly correlated with left ventricular mass 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 occurrence of extrasystolies, were encountered in the patients during 24-h continuous 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 cardiovascular disease, higher cardioactive drug consumption, and an increased prevalence of cardiovascular risk factors. The increased cardiovascular morbidity could not be ascribed to inadequate estrogen or thyroid hormone treatment, and unsubstituted GH deficiency is probably an important contributing factor.
我们最近报告称，患有垂体功能减退症的女性患者，在接受甲状腺和类固醇激素替代治疗且病情得到控制，但未接受生长激素（GH）替代治疗的情况下，与普通人群相比，心血管疾病死亡率增加了两倍多。在本研究中，我们调查了33名患垂体功能减退症6至46年（中位数为18年）的女性的心血管疾病发病率以及心血管危险因素的患病率，并与从同一地理区域的普通人群中招募的33名对照受试者进行了比较，这些对照受试者在性别、年龄、吸烟习惯、教育水平和居住地点方面相匹配。这些患者极有可能存在生长激素缺乏，因为29名患者的血清胰岛素样生长因子I水平低于正常范围，另外4名患者经胰岛素耐量试验评估为生长激素缺乏。垂体功能减退症患者的心血管疾病发病率显著更高（发病率比为3.7；95%置信区间为1.2至11.3），心血管活性药物的消耗量也显著更高（P = 0.002）。垂体功能减退症患者在业余时间的体育锻炼程度较低（P = 0.02），腰臀比更高（P = 0.01），高密度脂蛋白胆固醇水平较低（P = 0.002），低密度脂蛋白/高密度脂蛋白比值更高（P = 0.009）。此外，患者的左心房大小显著增加（P = 0.05），但在其他心脏指标方面未观察到差异。在这些患者中，血清胰岛素样生长因子I水平与左心室质量指数显著相关（r = 0.48；P = 0.006），这表明生长激素对心脏大小有强烈影响。在24小时连续心电图监测期间，患者出现心动过缓的次数更多（P = 0.05），但室性早搏的发生率并未增加。患者与对照组之间的颈动脉内膜中层厚度和斑块数量没有差异。总之，垂体功能减退的女性表现出心血管疾病发病率增加、心血管活性药物消耗量增加以及心血管危险因素患病率增加。心血管发病率的增加不能归因于雌激素或甲状腺激素治疗不足，未补充生长激素缺乏可能是一个重要的促成因素。
