Abstract
BackgroundHypopituitarism in the elderly population is an underdiagnosed condition and may increase comorbidities related to glucose metabolism, dyslipidemia, and cardiovascular risk factors. Optimization of hormone replacement take into account alterations in clearence rates of hormones, interaction with other medications, and evaluation of the risk-benefit ratio of treatment is a big challenge for clinical practice. ObjectivesThis study aimed to evaluate classic cardiovascular risk factors in hypopituitary septuagenarians and octagenarians by diagnosis and after long-term hormone replacement.MethodsThis is a retrospective observational study, and patients were recruited and selected from a registry in a tertiary medical center. We included patients aged from 70-99 years with hypopituitarism, evaluated hormonal and biochemical parameters, cardiovascular risk scores were calculated by diagnosis and compared after long-term follow-up. All patients signed informed consent. Patients' data were compared to a sex and age-matched control group, with long-term geriatric follow up, without endocrine diseases.ResultsThirty-five patients were included, 16 patients aged 70-75 years (72.61), 12 patients 76-80 years (72.28), 7 patients 81-99 years (89.28). Pituitary macroadenomas were the main cause of hypopituitarism, mean maximal diameter 3.4 cm (2.9- 4.3), and invasive craniopharyngiomas. At the moment of diagnosis, most patients were overweight, and abdominal adiposity was observed in 76.9% of women and 36.4% of men, mostly in octagenarians and nonagenarians. Co-morbidities were frequent, 85.7% presented Hypertension, 37.1% Diabetes, 53.1% low HDL, 51.5% hypertriglyceridemia. Most patients presented more than two combined pituitary deficiencies, hypogonadism in 88.6%, central hypothyroidism 82.9%, GH deficiency in 65.7%, and adrenal insufficiency in 25.7%. Analysis of cardiovascular risk prediction in the total cohort showed that 57.1% of patients presented a reduction in the General Cardiovascular Disease (CVD) Risk Prediction Score and 45.7% in atherosclerotic CVD risk estimated by ACC/AHA 2013 Pooled Cohort Equation, despite being submitted to conventional hormone replacement, during the meantime follow up pf 14.5 years. This reduction was not observed in the control group.Discussion and ConclusionIn this study, aged hypopituitary patients presented a reduction in estimated general CVD risk during long-term follow-up, despite replacement with corticosteroids, levothyroxine, or gonadal steroids. The early diagnosis and treatment of hypopituitarism in the elderly remain challenging. Larger studies should be performed to assess the risk-benefit ratio of hormone replacement in the metabolic profile in septuagenarian and octogenarian patients.
Diagnosis and Treatment of Pituitary Adenomas
