Bülow B, Hagmar L, Mikoczy Z, Nordström C H, Erfurth E M
Department of Internal, Medicine, University Hospital, Lund, Sweden.
Clin Endocrinol (Oxf). 1997 Jan;46(1):75-81. doi: 10.1046/j.1365-2265.1997.d01-1749.x.
An increased prevalence of atherosclerosis has been shown among patients with hypopituitarism. The aim of the present study was to assess whether patients with hypopituitarism experience increased cardiovascular, in particular cerebrovascular, mortality.
Retrospective cohort study of mortality, 1952-1992, in 344 patients, of whom 130 were female, receiving conventional hormone replacement for hypopituitarism following neurosurgery for pituitary tumours. The general population in the catchment area of southern Sweden from which the patients were recruited constituted the reference population. Expected mortality was obtained from cause, sex, calendar year, and 5-year age-specific death raise for the area.
Increased mortality from cerebrovascular disease (standardized mortality ratio (SMR) 3.39; 95% CI 2.27-4.99) was the main contributor to the increased overall cardiovascular mortality (SMR 1.75; 95% CI 1.40-2.19). The increase in mortality from cardiac diseases was much smaller (SMR 1.41; 95% CI 1.04-1.88). The risk for cerebrovascular death was higher in women (SMR 4.91) than in men (SMR 2.64). The relative risk for cerebrovascular death was independent of the time interval since diagnosis of pituitary insufficiency, but was greater in subjects diagnosed at an earlier age (< 55 years). No increased mortality in malignant tumours was observed (SMR 0.95; 95% CI 0.60-1.48).
The increased cerebrovascular mortality may be due to GH deficiency, or to long-term lack or inadequacy of substitution for other pituitary hormones. The observations that an early onset of pituitary insufficiency and female sex are predictors for a high risk for cerebrovascular mortality merit particular attention when treating this group of patients.
已有研究表明垂体功能减退患者动脉粥样硬化患病率增加。本研究旨在评估垂体功能减退患者的心血管疾病，尤其是脑血管疾病死亡率是否增加。
对1952年至1992年间344例患者的死亡率进行回顾性队列研究，其中130例为女性，这些患者因垂体肿瘤接受神经外科手术后接受常规垂体功能减退激素替代治疗。招募这些患者的瑞典南部集水区的普通人群作为参考人群。预期死亡率根据该地区的病因、性别、日历年和5年年龄别死亡率得出。
脑血管疾病死亡率增加（标准化死亡率比（SMR）3.39；95%可信区间2.27 - 4.99）是总体心血管死亡率增加（SMR 1.75；95%可信区间1.40 - 2.19）的主要原因。心脏病死亡率的增加幅度小得多（SMR 1.41；95%可信区间1.04 - 1.88）。女性脑血管死亡风险（SMR 4.91）高于男性（SMR 2.64）。脑血管死亡的相对风险与垂体功能不全诊断后的时间间隔无关，但在诊断时年龄较小（<55岁）的受试者中更高。未观察到恶性肿瘤死亡率增加（SMR 0.95；95%可信区间0.60 - 1.48）。
脑血管死亡率增加可能是由于生长激素缺乏，或长期缺乏或替代其他垂体激素不足。垂体功能不全早发和女性是脑血管高死亡率预测因素的观察结果在治疗这组患者时值得特别关注。
