Emerging cardiovascular risk factors/markers such as proinflammatory cytokines , C-reactive protein , and adipokines are also increased in GHD patients .
Increased cardiovascular morbidity and mortality have also been reported in GHD .
GH treatment has been shown to improve both traditional and emerging cardiovascular risk factors and markers .
The GHD population may be considered at high cardiovascular risk , and GH substitution may be expected to bring an added value to patients with hypopituitarism in terms of cardiovascular protection .
CONTEXT GH deficiency ( GHD ) of the adult is a clinical condition characterized by the presence of several traditional and emerging cardiovascular risk factors that can significantly increase cardiovascular morbidity and mortality .
It is still an open issue whether GH replacement is able not only to improve cardiovascular risk factors but also to decrease cardiovascular morbidity and mortality .
EVIDENCE SYNTHESIS In untreated GHD , cardiovascular risk is increased due to abnormal lipid profile ( increased total and low-density lipoprotein cholesterol , increased triglycerides , and reduced high-density lipoprotein cholesterol ) and impaired glucose metabolism .
Association between premature mortality and hypopituitarism. West Midlands Prospective Hypopituitary Study Group.
BACKGROUND Four retrospective studies have reported premature mortality in patients with hypopituitarism with st and ard mortality ratios ( SMRs ) varying between 1.20 and 2.17 . Patients with hypopituitarism have complex endocrine deficiencies , and the mechanisms underpinning any excess mortality are unknown . Furthermore , the suggestion has emerged that endogenous growth-hormone deficiency might account for any excess mortality . We aim ed to clarify these issues by doing a large prospect i ve study of total and specific-cause mortality in patients with hypopituitarism . METHODS We followed up 1014 UK patients ( 514 men , 500 women ) with hypopituitarism from January , 1992 , to January , 2000 . 573 ( 57 % ) patients had non-functioning adenomas , 118 ( 12 % ) craniopharyngiomas , and 93 ( 9 % ) prolactinomas .  SMRs were calculated as the ratio of observed deaths to the number of deaths in an age-matched and sex-matched UK population . FINDINGS The number of observed deaths was 181 compared with the 96.7 expected ( SMR 1.87 [ 99 % CI 1.62 - 2.16 ] , p<0.0001 ) . Univariate analysis indicated that mortality was higher in women ( 2.29 [ 1.86 - 2.82 ] ) than men ( 1.57 [ 1.28 - 1.93 ] , p=0.002 ) , in younger patients , in patients with an underlying diagnosis of craniopharyngioma ( 9.28 [ 5.84 - 14.75 ] vs 1.61 [ 1.30 - 1.99 ] , p<0.0001 ) , and in the 353 patients treated with radiotherapy ( 2.32 [ 1.71 - 3.14 ] vs 1.66 [ 1.30 - 2.13 ] , p=0.004 ) . Excess mortality was attributed to cardiovascular ( 1.82 [ 1.30 - 2.54 ] , p<0.0001 ) , respiratory ( 2.66 [ 1.72 - 4.11 ] , p<0.0001 ) , and cerebrovascular ( 2.44 [ 1.58 - 4.18 ] , p<0.0001 ) causes . There was no effect of hormonal deficiency on mortality , except for gonadotropin deficiency , which , if untreated was associated with excess mortality ( untreated 2.97 [ 2.13 - 4.13 ] vs treated 1.42 [ 0.97 - 2.07 ] , p<0.0001 ) . Multiple regression analyses identified age at diagnosis , sex , a diagnosis of craniopharyngioma , and untreated gonadotropin deficiency as independent significant factors affecting mortality . INTERPRETATION Patients with hypopituitarism have excess mortality , predominantly from vascular and respiratory disease . Age at diagnosis , female sex , and above all , craniopharyngioma were significant independent risk factors . Specific endocrine-axis deficiency , with the exception of untreated gonadotropin deficiency , does not seem to have a role
Emerging cardiovascular risk factors/markers such as proinflammatory cytokines , C-reactive protein , and adipokines are also increased in GHD patients .
Increased cardiovascular morbidity and mortality have also been reported in GHD .
GH treatment has been shown to improve both traditional and emerging cardiovascular risk factors and markers .
The GHD population may be considered at high cardiovascular risk , and GH substitution may be expected to bring an added value to patients with hypopituitarism in terms of cardiovascular protection .
CONTEXT GH deficiency ( GHD ) of the adult is a clinical condition characterized by the presence of several traditional and emerging cardiovascular risk factors that can significantly increase cardiovascular morbidity and mortality .
It is still an open issue whether GH replacement is able not only to improve cardiovascular risk factors but also to decrease cardiovascular morbidity and mortality .
EVIDENCE SYNTHESIS In untreated GHD , cardiovascular risk is increased due to abnormal lipid profile ( increased total and low-density lipoprotein cholesterol , increased triglycerides , and reduced high-density lipoprotein cholesterol ) and impaired glucose metabolism .