Is treated hypopituitarism associated with increased left ventricular strains?-detailed analysis from the three-dimensional speckle-tracking echocardiographic MAGYAR-Path Study

Abstract

Reduced secretion of one or more of the hormones normally produced by the pituitary gland is called hypopituitarism, which is a rare and frequently underdiagnosed condition. Hypopituitarism can be present at birth called congenital or may develop due to acquired causes like tumor, infection, infiltration, vascular or other causes. Symptoms of hypopituitarism are highly dependent on which hormones are insufficient. The present prospective study was designed to test whether treated hypopituitarism is associated with changes in 3DSTE-derived LV strains in patients without known cardiovascular disorder. We investigated 38 patients with treated hypopituitarism who were in sinus rhythm (57.0±13.6 years, 19 males), 6 patients were excluded from the study due to inferior image quality. The remaining patient group consisted of 16 patients with congenital hypopituitarism and 16 patients with acquired form of hypopituitarism. Their results were compared to age- and gender-matched controls (mean age: 55.3±4.7 years, 14 males). Out of the 32 patients with hypopituitarism, 30 patients had growth hormone deficiency, 27 patients had central adrenal insufficiency, 12 patients had central hypothyroidism, 12 patients had hypogonadotropic hypogonadism and 5 patients had diabetes insipidus. Only LV longitudinal and area strains proved to be significantly increased in patients with hypopituitarism, other LV strains did not differ between patients and controls. No significant differences could be confirmed in LV strains between patients with congenital and acquired hypopituitarism. It could be concluded that longitudinal LV strains are increased in both congenital and acquired treated hypopituitarism.

Keywords: Left ventricular strain; echocardiography; hypopituitarism; three-dimensional.

Figure 1

Images from a three-dimensional (3D) speckle-tracking echocardiographic analysis in a healthy subject (A) and in a patient with hypopituitarism (B) are demonstrated presenting an apical four-chamber view (A), apical two-chamber view (B) and apical (C3), mid-ventricular (C5) and basal (C7) left ventricular (LV) short-axis views together with LV volumetric data in respect with cardiac cycle and time – LV segmental longitudinal strain curves (coloured lines) with bull’s eye display and a time-volume changes curve (dashed line) during the cardiac cycle. LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle.