Comorbidity and cardiovascular risk factors in adult GH deficiency following treatment for Cushing's disease or non-functioning pituitary adenomas during childhood

• Published in: European journal of endocrinology Vol. 166; no. 4; pp. 593 - 600
• Main Authors: Ragnarsson, Oskar, Höybye, Charlotte, Jönsson, Peter J, Feldt-Rasmussen, Ulla, Johannsson, Gudmundur, Biller, Beverly M K, Kołtowska-Häggström, Maria
• Format: Journal Article
• Language: English
• Published: Bristol BioScientifica 01.04.2012
• Subjects: Adenoma - complications; Adenoma - epidemiology; Adolescent; Adrenals. Adrenal axis. Renin-angiotensin system (diseases); Adult; Age; Age of Onset; Biological and medical sciences; Cadmium; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - etiology; Child; Children; Clinical Study; Comorbidity; Endocrinopathies; Female; Fundamental and applied biological sciences. Psychology; Hormones; Human Growth Hormone - deficiency; Humans; Hypertension; Hypothalamus. Hypophysis. Epiphysis (diseases); Male; Medical sciences; Middle Aged; Morbidity; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Pituitary ACTH Hypersecretion - complications; Pituitary ACTH Hypersecretion - epidemiology; Pituitary Neoplasms - complications; Pituitary Neoplasms - epidemiology; Retrospective Studies; Risk Factors; Vertebrates: endocrinology; Young Adult; Norway, Oslo; Human; Endocrinopathy; Adrenal cortex diseases; Hormone therapy; Deficiency; Cushing syndrome; Cardiovascular disease; Hyperadrenocorticism; Somatotropin; Concomitant disease; Adenohypophyseal hormone; Polypathology; Pituitary diseases; Adrenal gland diseases; Risk factor; Cardiovascular risk; Pituitary adenoma; Adult; Child; Endocrinology
• ISSN: 0804-4643; 1479-683X; 1479-683X
• DOI: 10.1530/EJE-11-0942

ObjectiveCushing's disease (CD) and non-functioning pituitary adenoma (NFPA) are rare in paediatric patients. The aim of this study was to describe long-term consequences in adults with GH deficiency (GHD) treated for CD or NFPA during childhood.Design, patients and methodsThis was a retrospective analysis of data from KIMS (Pfizer International Metabolic Database). Background characteristics, anthropometry and comorbidity were studied in 47 patients diagnosed with childhood-onset (CO)-CD and 62 patients with CO-NFPA. Data from 100 ACTH-sufficient patients with CO-idiopathic hypopituitarism (CO-Idio) were used for comparison. Cardiovascular risk profile was analysed at baseline and at 1 year on GH treatment in a subgroup of patients (17 CO-CD, 24 CO-NFPA and 55 CO-Idio) not receiving GH treatment at study entry.ResultsThe median age at diagnosis of pituitary tumour was 14.0 years (range 10–17) in patients with CO-CD and 13.7 years (range 8–17) in CO-NFPA. In addition to GHD, 41% of patients with CO-CD had three or four other pituitary hormone deficiencies compared with 78% of patients with CO-NFPA (P<0.001). Eighty-nine per cent of patients with CO-CD had height SDS lower than 0 compared with 61% of patients with CO-NFPA (P=0.002). Hypertension was more common in CO-CD compared with CO-Idio (23 vs 9%, P=0.018). At 1 year on GH treatment, total- and low-density lipoprotein-cholesterol decreased significantly in CO-CD but not in CO-NFPA.ConclusionAdult patients with GHD following treatment for paediatric CD and NFPA have long-term adverse consequences. Despite more severe hypopituitarism in CO-NFPA, patients with CO-CD have more frequently compromised final stature.