Erhöhte Prävalenz von Osteoporose und Arteriosklerose bei konventionell substituierter Hypophysenvorderlappeninsuffizienz: Bedarf einer zusätzlichen Wachstumshormonsubstitution?
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Prospektive Cardiovaskuläre Münster Studie (1)
Thyreotropin releasing hormone
Thyreoidea stimulierendes Hormon
Luteinisierendes hormone releasing hormone
Single-Photonen-Absorptiometrie, distaler Unterarm
dito, proximaler Unterarm
Increased prevalence of osteoporosis and arteriosclerosis in patients with conventionally substituted pituitary insufficiency: Is there a need for additional growth hormone substitution?
In a retrospective study of 632 patients with pituitary disease we diagnosed pituitary insufficiency without hypersecretion of any pituitary hormone in 122 patients. Patients were substituted with sex hormones (76%), hydrocortisone (74%) and/or L-thyroxine (77%). 76% had additional growth hormone deficiency, as shown by an increase of growth hormone of less than 5 ng/ml after i.v. administration of L-arginine. In 17% of all patients the diagnosis of osteoporosis was proven or suspected radiologically. 57% had low bone mass of lumbar spine (dualphotonabsorptiometry) and 73% had low bone mass of the proximal forearm (singlephotonabsorptiometry). BMD values of pituitary insufficient patients were in the same range as those of patients with established osteoporosis.
More than half of all patients (53%) complained of tiredness, exhaustion and muscle weakness. 40% suffered from adipositas. 77% had hyperlipidemia (68% hypertriglyceridemia and 42% hypercholesterinemia), 18% had hypertension. 14% of the patients had arteriosclerotic events in their history (myocardial infarction or stroke). These figures are higher than incidences shown in the German PROCAM-study. These data show an increased prevalence of osteoporosis and vascular diseases. This is in contrast to the general opinion, that patients with pituitary insufficiency are adequately treated by substitution with adrenal, thyroid and sex hormones. Whether other factors such as the additional growth hormone deficiency are responsible for these diseases has to be examined in prospective studies.
Key wordsPituitary insufficiency Osteoporosis Bone mineral density Arteriosclerosis Hyperlipidemia Growth hormone deficiency
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