Boschetti Mara, Agosti Sergio, Albanese Valeria, Casalino Laura, Teti Claudia, Bezante Gian Paolo, Brunelli Claudio, Albertelli Manuela, Ferone Diego
Endocrinology Unit (DiMI), Department of Internal Medicine & Medical Specialties, IRCCS AOU San Martino-IST, University of Genoa, Viale Benedetto XV, 6, 16132, Genoa, Italy.
Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy.
Endocrine. 2017 Feb;55(2):573-581. doi: 10.1007/s12020-016-0951-4. Epub 2016 Apr 13.
Hypopituitarism reduces life expectancy and increases the risk of cardiovascular and cerebrovascular diseases, as well as death. Abnormalities in the cardiovascular system may be independently related to GH deficiency (GHD). The aim of this study was to prospectively investigate coronary flow reserve and diastolic function in GHD adult patients at diagnosis and after 1 year of GH replacement therapy. As control group, an age- and sex-matched population was chosen. All patients and controls were non-smokers, non-diabetic, and normotensive, with no history of vascular disease. 14 patients with adult-onset GHD and 17 controls represent the two study groups. Anthropometric data, blood pressure, lipid profile, glycosylated hemoglobin (HbA1c) and IGF-I plasma levels, coronary flow reserve (CFR), and LV diastolic function (evaluated by E/A) were collected in all subjects before and after 12 months of GH replacement therapy. Compared with controls, systolic and diastolic blood pressure and LDL cholesterol levels were significantly higher at baseline and return, comparable to controls after 1 year of GH replacement (GHRT). GHD patients showed a blunted CFR at baseline (P < 0.001) and a significant improvement after GHRT, returning to values comparable with those recorded in the control group. In addition, after therapy a significant (P < 0.001) improvement in E/A was recorded. One year of GH therapy improves CFR and E/A in the patient population analyzed, thereby encouraging the early start of GHRT.
垂体功能减退会缩短预期寿命，增加心血管和脑血管疾病以及死亡风险。心血管系统异常可能与生长激素缺乏（GHD）独立相关。本研究的目的是前瞻性调查GHD成年患者诊断时及生长激素替代治疗1年后的冠状动脉血流储备和舒张功能。作为对照组，选择了年龄和性别匹配的人群。所有患者和对照均不吸烟、无糖尿病且血压正常，无血管疾病史。14例成年起病的GHD患者和17例对照代表两个研究组。在生长激素替代治疗12个月前后，收集了所有受试者的人体测量数据、血压、血脂谱、糖化血红蛋白（HbA1c）和IGF-I血浆水平、冠状动脉血流储备（CFR）和左室舒张功能（通过E/A评估）。与对照组相比，收缩压和舒张压以及低密度脂蛋白胆固醇水平在基线和复诊时显著更高，生长激素替代治疗（GHRT）1年后与对照组相当。GHD患者在基线时CFR降低（P < 0.001），GHRT后有显著改善，恢复到与对照组记录值相当的水平。此外，治疗后E/A有显著（P < 0.001）改善。1年的生长激素治疗改善了所分析患者群体的CFR和E/A，从而鼓励尽早开始GHRT。
