Metabolic Syndrome in Hypopituitarism

Prevalence of metabolic syndrome (MetS) and mortality rates from cardiovascular causes are increased in patients with hypopituitarism. Features of obesity, visceral adiposity, dyslipidemia, insulin resistance, and hypertension are common in these patients. Unreplaced growth hormone (GH) deficiency and inadequate replacement of other hormone insufficiencies may be responsible for the adverse body composition and metabolic profile associated with hypopituitarism. Recently, fatty liver disease was added to this unfavorable metabolic phenotype. Long-term treatment with low-dose GH replacement is considered safe and advantageous for metabolic profile and normalization of cardiovascular mortality rates in hypopituitary patients. Positive influence of optimal balance in replacement of other pituitary hormone deficiencies with doses of hydrocortisone (<20 mg/day), weight-adjusted T4 doses, and transdermal estrogen in women is also very important. Active screening and treatment of all cardiometabolic risk factors and comorbidities may further improve outcomes in patients with hypopituitarism.