Hypopituitarism Induced by Continuous Infusion of PGI2 Analogues: A Case Series and the Role of ACTH Screening and Hydrocortisone Treatment
ABSTRACT Hypopituitarism has been reported in patients receiving continuous infusions of prostaglandin I2 (PGI2) analogues for pulmonary hypertension (PH). However, these patients' clinical characteristics, treatment, and prognoses remain unclear. This retrospective multicentre study included 2...
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2025-04-01
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| Series: | Pulmonary Circulation |
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| Online Access: | https://doi.org/10.1002/pul2.70116 |
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| author | Taijyu Satoh Yuichi Tamura Noriaki Takama Hiromi Matsubara Nobuhiro Tanabe Takumi Inami Takahiro Hiraide Kohtaro Abe Yoshihiro Dohi Yoshito Ogihara Takeshi Ogo Shiro Adachi Kazuhiko Nakazato Ichizo Tsujino Hideki Ota Kohei Komaru Haruka Sato Yuta Tezuka Yoshikiyo Ono Rika Suda Kazuya Hosokawa Sarasa Isobe Takatoyo Kiko Yuki Koga Junichi Nakamura Koichiro Sugimura Masaru Hatano Yoshihiro Fukumoto Satoshi Yasuda |
| author_facet | Taijyu Satoh Yuichi Tamura Noriaki Takama Hiromi Matsubara Nobuhiro Tanabe Takumi Inami Takahiro Hiraide Kohtaro Abe Yoshihiro Dohi Yoshito Ogihara Takeshi Ogo Shiro Adachi Kazuhiko Nakazato Ichizo Tsujino Hideki Ota Kohei Komaru Haruka Sato Yuta Tezuka Yoshikiyo Ono Rika Suda Kazuya Hosokawa Sarasa Isobe Takatoyo Kiko Yuki Koga Junichi Nakamura Koichiro Sugimura Masaru Hatano Yoshihiro Fukumoto Satoshi Yasuda |
| author_sort | Taijyu Satoh |
| collection | DOAJ |
| description | ABSTRACT Hypopituitarism has been reported in patients receiving continuous infusions of prostaglandin I2 (PGI2) analogues for pulmonary hypertension (PH). However, these patients' clinical characteristics, treatment, and prognoses remain unclear. This retrospective multicentre study included 22 patients who developed hypopituitarism while on continuous PGI2 analogue infusion between 1999 and 2021. All patients were female, and idiopathic pulmonary arterial hypertension was the most common underlying condition (63.6%). Their mean age was 38.8 ± 7.9 years. Epoprostenol was the predominant PGI2 analogue used (90.9%). At the time of hypopituitarism onset, the median PGI2 dose was 67.2 ng/kg/min (31.8–88.7 ng/kg/min), and the median treatment duration was 889.0 days (450.5–1941.5 days), suggesting that hypopituitarism occurred independent of its dose or treatment duration. Diagnoses were based on decreased adrenocorticotropic hormone levels. The hypopituitarism classification revealed isolated pituitary dysfunction in 54.5% of the cases, partial dysfunction in 18.1%, and complete dysfunction in 27.2%. Most cases could be managed without requiring specific therapies. After hypopituitarism onset, 63.6% of the patients continued to receive the same PGI2 analogue. Hydrocortisone therapy was administered to 81.8% of the patients, leading to clinical stabilisation. No deaths were reported. In conclusions, hypopituitarism may occur during continuous PGI2 analogue infusion for PH, irrespective of its dose or treatment duration. Initiating hydrocortisone therapy may be important for stabilising the clinical course. |
| format | Article |
| id | doaj-art-d8c2fe2d246345539ce638f2ae0f6b51 |
| institution | Matheson Library |
| issn | 2045-8940 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Wiley |
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| series | Pulmonary Circulation |
| spelling | doaj-art-d8c2fe2d246345539ce638f2ae0f6b512025-06-30T00:16:44ZengWileyPulmonary Circulation2045-89402025-04-01152n/an/a10.1002/pul2.70116Hypopituitarism Induced by Continuous Infusion of PGI2 Analogues: A Case Series and the Role of ACTH Screening and Hydrocortisone TreatmentTaijyu Satoh0Yuichi Tamura1Noriaki Takama2Hiromi Matsubara3Nobuhiro Tanabe4Takumi Inami5Takahiro Hiraide6Kohtaro Abe7Yoshihiro Dohi8Yoshito Ogihara9Takeshi Ogo10Shiro Adachi11Kazuhiko Nakazato12Ichizo Tsujino13Hideki Ota14Kohei Komaru15Haruka Sato16Yuta Tezuka17Yoshikiyo Ono18Rika Suda19Kazuya Hosokawa20Sarasa Isobe21Takatoyo Kiko22Yuki Koga23Junichi Nakamura24Koichiro Sugimura25Masaru Hatano26Yoshihiro Fukumoto27Satoshi Yasuda28Department of Cardiovascular Medicine Tohoku University Graduate School of Medicine Sendai JapanPulmonary Hypertension Center International University of Health and Welfare Mita Hospital Tokyo JapanDepartment of Cardiovascular Medicine Gunma University Graduate School of Medicine Maebashi JapanDepartment of Cardiology Okayama Medical Center Okayama JapanPulmonary Hypertension Center Chibaken Saiseikai Narashino Hospital Chiba JapanDepartment of Cardiovascular Medicine Kyorin University School of Medicine Mitaka JapanDepartment of Cardiology Keio University School of Medicine Tokyo JapanDepartment of Cardiovascular Medicine, Faculty of Medical Sciences Kyushu University Fukuoka JapanDepartment of Cardiovascular Medicine Kure Kyosai Hospital Kure JapanDepartment of Cardiology and Nephrology Mie University Graduate School of Medicine Tsu JapanDivision of Pulmonary Circulation Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka JapanDepartment of Cardiology Nagoya University Hospital Nagoya JapanDepartment of Cardiovascular Medicine Fukushima Medical University School of Medicine Fukushima JapanDepartment of Respiratory Medicine, Faculty of Medicine Hokkaido University Sapporo Hokkaido JapanDepartment of Diagnostic Radiology Tohoku University Hospital Sendai JapanDepartment of Cardiovascular Medicine Tohoku University Graduate School of Medicine Sendai JapanDepartment of Cardiovascular Medicine Tohoku University Graduate School of Medicine Sendai JapanDepartment of Diabetes, Metabolism and Endocrinology Tohoku University Hospital Sendai JapanDepartment of Diabetes, Metabolism and Endocrinology Tohoku University Hospital Sendai JapanPulmonary Hypertension Center Chibaken Saiseikai Narashino Hospital Chiba JapanDepartment of Cardiovascular Medicine, Faculty of Medical Sciences Kyushu University Fukuoka JapanPulmonary Hypertension Center International University of Health and Welfare Mita Hospital Tokyo JapanDivision of Pulmonary Circulation Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka JapanDivision of Cardiovascular Medicine, Department of Internal Medicine Kurume University School of Medicine Kurume JapanDepartment of Respiratory Medicine, Faculty of Medicine Hokkaido University Sapporo Hokkaido JapanDepartment of Cardiology International University of Health and Welfare Narita Hospital Tokyo JapanDepartment of Cardiovascular Medicine, Graduate School of Medicine The University of Tokyo JapanDivision of Cardiovascular Medicine, Department of Internal Medicine Kurume University School of Medicine Kurume JapanDepartment of Cardiovascular Medicine Tohoku University Graduate School of Medicine Sendai JapanABSTRACT Hypopituitarism has been reported in patients receiving continuous infusions of prostaglandin I2 (PGI2) analogues for pulmonary hypertension (PH). However, these patients' clinical characteristics, treatment, and prognoses remain unclear. This retrospective multicentre study included 22 patients who developed hypopituitarism while on continuous PGI2 analogue infusion between 1999 and 2021. All patients were female, and idiopathic pulmonary arterial hypertension was the most common underlying condition (63.6%). Their mean age was 38.8 ± 7.9 years. Epoprostenol was the predominant PGI2 analogue used (90.9%). At the time of hypopituitarism onset, the median PGI2 dose was 67.2 ng/kg/min (31.8–88.7 ng/kg/min), and the median treatment duration was 889.0 days (450.5–1941.5 days), suggesting that hypopituitarism occurred independent of its dose or treatment duration. Diagnoses were based on decreased adrenocorticotropic hormone levels. The hypopituitarism classification revealed isolated pituitary dysfunction in 54.5% of the cases, partial dysfunction in 18.1%, and complete dysfunction in 27.2%. Most cases could be managed without requiring specific therapies. After hypopituitarism onset, 63.6% of the patients continued to receive the same PGI2 analogue. Hydrocortisone therapy was administered to 81.8% of the patients, leading to clinical stabilisation. No deaths were reported. In conclusions, hypopituitarism may occur during continuous PGI2 analogue infusion for PH, irrespective of its dose or treatment duration. Initiating hydrocortisone therapy may be important for stabilising the clinical course.https://doi.org/10.1002/pul2.70116hypopituitarismPGI2 analoguepulmonary hypertension |
| spellingShingle | Taijyu Satoh Yuichi Tamura Noriaki Takama Hiromi Matsubara Nobuhiro Tanabe Takumi Inami Takahiro Hiraide Kohtaro Abe Yoshihiro Dohi Yoshito Ogihara Takeshi Ogo Shiro Adachi Kazuhiko Nakazato Ichizo Tsujino Hideki Ota Kohei Komaru Haruka Sato Yuta Tezuka Yoshikiyo Ono Rika Suda Kazuya Hosokawa Sarasa Isobe Takatoyo Kiko Yuki Koga Junichi Nakamura Koichiro Sugimura Masaru Hatano Yoshihiro Fukumoto Satoshi Yasuda Hypopituitarism Induced by Continuous Infusion of PGI2 Analogues: A Case Series and the Role of ACTH Screening and Hydrocortisone Treatment Pulmonary Circulation hypopituitarism PGI2 analogue pulmonary hypertension |
| title | Hypopituitarism Induced by Continuous Infusion of PGI2 Analogues: A Case Series and the Role of ACTH Screening and Hydrocortisone Treatment |
| title_full | Hypopituitarism Induced by Continuous Infusion of PGI2 Analogues: A Case Series and the Role of ACTH Screening and Hydrocortisone Treatment |
| title_fullStr | Hypopituitarism Induced by Continuous Infusion of PGI2 Analogues: A Case Series and the Role of ACTH Screening and Hydrocortisone Treatment |
| title_full_unstemmed | Hypopituitarism Induced by Continuous Infusion of PGI2 Analogues: A Case Series and the Role of ACTH Screening and Hydrocortisone Treatment |
| title_short | Hypopituitarism Induced by Continuous Infusion of PGI2 Analogues: A Case Series and the Role of ACTH Screening and Hydrocortisone Treatment |
| title_sort | hypopituitarism induced by continuous infusion of pgi2 analogues a case series and the role of acth screening and hydrocortisone treatment |
| topic | hypopituitarism PGI2 analogue pulmonary hypertension |
| url | https://doi.org/10.1002/pul2.70116 |
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