Inflammatory Cardiovascular Risk Markers in Women with Hypopituitarism

• Published in: The journal of clinical endocrinology and metabolism Vol. 86; no. 12; pp. 5774 - 5781
• Main Authors: Sesmilo, Gemma, Miller, Karen K., Hayden, Douglas, Klibanski, Anne
• Format: Journal Article
• Language: English
• Published: Endocrine Society 01-12-2001
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jcem.86.12.8087

Patients with hypopituitarism have increased cardiovascular
mortality. A high prevalence of conventional cardiovascular risk
factors, including obesity, central fat distribution, insulin
resistance, and dyslipidemia, have been described in these patients.
The inflammatory markers C-reactive protein (CRP) and IL-6 are
predictors of cardiovascular events, and high levels of CRP have been
reported in men with hypopituitarism and GH deficiency. However, little
is known about inflammatory cardiovascular risk markers in women with
hypopituitarism.
We therefore investigated whether inflammatory and traditional
cardiovascular risk markers are elevated in women with hypopituitarism.
Fifty-three women with hypopituitarism and 111 healthy control women
were included in this cross-sectional study. Morning blood samples were
drawn after an overnight fast. Serum was assayed for CRP, IL-6,
glucose, insulin, IGF-I, triglycerides, total cholesterol, low density
lipoprotein cholesterol, high density lipoprotein (HDL) cholesterol,
lipoprotein(a), E2, total testosterone (total T) and free
testosterone (free T), and dehydroepiandrosterone sulfate.
IL-6 and CRP levels were higher in women with hypopituitarism than in
healthy controls (P < 0.0001 for comparison
between groups). In a multivariate model, CRP levels depended on
hypopituitarism, body mass index (BMI), and estrogen use. There was an
interaction between the effect of BMI and hypopituitarism on CRP
levels, such that the importance of hypopituitarism in determining CRP
levels disappeared at high BMIs. In a similar multivariate model, IL-6
levels depended on hypopituitarism and BMI. Total cholesterol, the
total to HDL cholesterol ratio, and triglycerides were higher in
hypopituitary patients, but only triglycerides and the total to HDL
cholesterol ratio depended on hypopituitarism when controlling for BMI.
There was no significant difference in lipoprotein(a) levels between
hypopituitary women and control subjects. However, when controlling for
estrogen use, lipoprotein(a) levels showed a trend toward being lower
in the hypopituitary group (P = 0.075). In patients
with hypopituitarism, CRP correlated negatively with IGF-I (r =−
0.35; P = 0.010), total T (r = −0.42;
P = 0.0020), and free T (r = −0.30;
P = 0.031). Similarly, IL-6 correlated negatively
with total T (r = −0.39; P = 0.0040) and
androstenedione (r = −0.27; P = 0.048) in
hypopituitary patients.
In conclusion, hypopituitary women have increased levels of IL-6 and
CRP, both of which are inflammatory markers of atherosclerosis. GH
deficiency and androgen deficiency may contribute to these findings.
Chronic inflammation may contribute to the high cardiovascular risk
seen in this population.