Hypopituitarism Induced by Continuous Infusion of PGI2 Analogues: A Case Series and the Role of ACTH Screening and Hydrocortisone Treatment

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.

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Publication Details

Journal
Pulmonary Circulation
Published
2025-04-01
DOI
https://doi.org/10.1002/pul2.70116
Citations
2
Primary Topic
Pulmonary Hypertension Research and Treatments
Type
article
Field-Weighted Citation Impact
3.04

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article

Hypopituitarism Induced by Continuous Infusion of PGI2 Analogues: A Case Series and the Role of ACTH Screening and Hydrocortisone Treatment

Hideki Ota, Nobuhiro Tanabe, Junichi Nakamura, Kohtaro Abe et al.
2 citations
Pulmonary Circulation
Pulmonary Hypertension Research and Treatments
3.04
article

Hypopituitarism Induced by Continuous Infusion of PGI2 Analogues: A Case Series and the Role of ACTH Screening and Hydrocortisone Treatment

Hideki Ota, Nobuhiro Tanabe, Junichi Nakamura, Kohtaro Abe, Taijyu Satoh, Haruka Sato, Masaru Hatano, Yoshikiyo Ono, Satoshi Yasuda, Ichizo Tsujino, Kazuhiko Nakazato, Noriaki Takama, Yoshihiro Fukumoto, Takeshi Ogo, Yuta Tezuka, Shiro Adachi, Sarasa Isobe, Kazuya Hosokawa, Takatoyo Kiko, Yoshihiro Dohi, Hiromi Matsubara, Yoshito Ogihara, Takahiro Hiraide, Koichiro Sugimura, Yuichi Tamura, Rika Suda, Yuki Koga, Kohei Komaru, Takumi Inami
article en
2 citations

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.

Pulmonary CirculationVol. 15(2)
Kurume University (JP), Fukushima Medical University (JP), Kyushu University (JP), Gunma University (JP), Mie University (JP), Kyorin University (JP), Tohoku University (JP), Keio University (JP), Hokkaido University (JP), Chibaken Saiseikai Narashino Hospital (JP), Nagoya University Hospital (JP), Tohoku University Hospital (JP), National Cerebral and Cardiovascular Center (JP), Kure Kyosai Hospital (JP), Okayama Medical Center (JP), Mita Hospital (JP), The University of Tokyo (JP), International University of Health and Welfare (JP)
Bristol-Myers Squibb, Pfizer, Boston Scientific Corporation, Bayer Yakuhin, Daiichi Sankyo Europe
Good health and well-being
Openalex Percentile: Top 9%
Pulmonary Hypertension Research and Treatments
3.04
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