Tuesday, December 29, 2009

Previous hypercortisolism exposure associated with Cushing’s disease increased risk for metabolic, vascular disorders

Researchers observed an increased three-year incidence of metabolic syndrome and prevalence of cardiovascular and cerebrovascular disease among growth hormone-treated patients with previous Cushing’s disease in a new study.

Researchers conducted a post hoc analysis of the observational Hypopituitary Control and Complications Study (1995-2006). The goal was to compare the prevalence and incidence of metabolic syndrome (using Adult Treatment Panel III criteria), diabetes, CV disease and cerebrovascular disease in patients with adult-onset GH deficiency who had previous Cushing’s disease (n=160) vs. previous nonfunctioning pituitary adenoma (n=879). All patients received GH, were GH-naïve at baseline and had multiple pituitary defects.

Patients with previous Cushing’s disease had a significantly greater three-year incidence of metabolic syndrome compared with previous nonfunctioning pituitary adenoma (23.4% vs. 9.2%; P=.01).

The prevalence of CVD was also greater among those with previous Cushing’s disease vs. nonfunctioning pituitary adenoma at baseline (6.3% vs. 2.2%; P<.01) and three-year follow-up (7.6% vs. 3.9%; P=.04). The researchers observed a similar trend for prevalence of cerebrovascular disease at baseline (6.4% vs. 1.8%; P=.03) and three years (10.2% vs. 2.9%; P=.01).

“These results suggest that previous exposure to hypercortisolism predisposes GH-deficient patients treated for Cushing’s disease to a greater risk of metabolic and vascular disease,” the researchers wrote. They suggested that clinicians “be especially mindful of the increased susceptibility of patients with previous Cushing’s disease to these conditions” when monitoring patients with pituitary disease.

Webb SM. J Clin Endocrinol Metab. 2009;doi: doi:10.1210/jc.2009-0806.

 

From http://www.endocrinetoday.com/view.aspx?rid=59583