Endocrine causes of heart failure: A clinical primer for cardiologists (original) (raw)

Endocrine system dysfunction and chronic heart failure: a clinical perspective

Endocrine, 2021

Chronic heart failure (CHF) leads to an excess of urgent ambulatory visits, recurrent hospital admissions, morbidity, and mortality regardless of medical and non-medical management of the disease. This excess of risk may be attributable, at least in part, to comorbid conditions influencing the development and progression of CHF. In this perspective, the authors examined and described the most common endocrine disorders observed in patients with CHF, particularly in individuals with reduced ejection fraction, aiming to qualify the risks, quantify the epidemiological burden and discuss about the potential role of endocrine treatment. Thyroid dysfunction is commonly observed in patients with CHF, and sometimes it could be the consequence of certain medications (e.g., amiodarone). Male and female hypogonadism may also coexist in this clinical context, contributing to deteriorating the prognosis of these patients. Furthermore, growth hormone deficiency may affect the development of adult...

Heart failure and neuroendocrine activation: diagnostic, prognostic and therapeutic perspectives

Clinical Physiology, 2001

The important neuroendocrine systems involved in heart failure are reviewed with special emphasis on their possible role in pathophysiology and their relation to prognostic and diagnostic information. Plasma levels of noradrenaline (NA), renin, vasopressin, endothelin-1, atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP) and tumour necrosis factor-a (TNF-a) are all elevated in heart failure. Activity of the sympathetic nervous system as re¯ected by NA is correlated to mortality and seems to possess independent prognostic information. Several studies have now documented the bene®cial effect of b-blockade in chronic heart failure (CHF). Renin seems to be a poor prognostic marker in CHF possibly because of the interference with diuretic treatment, angiotensin converting enzyme (ACE)-inhibitors and angiotensin II antagonist, and probably also because of the signi®cance of tissue renin-angiotensin system (RAS), poorly re¯ected by plasma renin. On the other hand, several large-scale trials with ACE-inhibitors and angiotensin II antagonists have demonstrated reduced mortality and morbidity in CHF. Plasma vasopressin does not seem to possess prognostic information but testing of non-peptide antagonists is ongoing. Endothelin-1 seems to have independent prognostic information and endothelin receptor antagonists may represent a therapeutic possibility.

Hormonal Profile in Patients With Dilated Cardiomyopathy

Research in Cardiovascular Medicine, 2015

Background: There is increasing evidence that endocrine system may be dysfunctional in patients with heart failure. Objectives: In the present study, we investigated hormonal abnormalities in heart failure and the effect of disturbed hormonal balance on prognostic outcomes of patients with systolic heart failure. Patients and Methods: Among patients followed in Heart Failure and Transplantation Clinic, 33 men with a diagnosis of idiopathic dilated cardiomyopathy receiving guidelines-directed medical therapies and with New York Heart Association Class II-III were enrolled. Serum concentrations of growth hormone (GH), insulin-like growth factor 1 (IGF-1), thyroid hormones, free testosterone, high-sensitive C-reactive protein (hs-CRP), and N-terminal pro-brain natriuretic peptide (NT Pro-BNP) were measured in all the patients. The physical performance of patients was assessed by six-minute walk test (6MWT). The patients were subsequently followed for a year and the data regarding their death, transplantation, or hospitalizations due to acute heart failure were recorded. Results: Except for testosterone level, the levels of GH, IGF-1, T3, and T4 concentrations in the patients were significantly lower than the normal values (P < 0.05). Among different hormone, only GH had correlation with NT Pro-BNP, hs-CRP, and 6MWT. There was no association between the occurrence of the combined events and different hormonal levels in multivariate analysis. Conclusions: The hormonal levels were low in patients with idiopathic dilated cardiomyopathy. However, the prognostic significance of different hormonal deficiencies was not clear in our study populations who were receiving standard therapies for heart failure and had a relatively stable clinical condition.

Effects of Hormonal Therapy in Patients with Heart Failure

Chronic heart failure is a multi-etiological disorder with high prevalence and poor prognosis. Several hormonal deficits have been observed in a consistent proportion of patients with this disease. Among them, testosterone deficiency and growth hormone/ insulin-like growth factor-1 axes impairment are highly prevalent and have been associated with a poor prognosis. Several experimental papers have highlighted the positive influence of growth hormone and testosterone in the regulation of heart development and performance. Moreover, many clinical studies have been started to investigate the effect of the administration of these two hormones in heart failure patients; a greater benefit has been evidenced in patients with hormonal deficiencies, by restoring physiological levels with hormonal therapy. These findings are promising, and, although not unanimously, indicate that both testosterone and growth hormone therapy should be considered as adjunctive therapy in advanced heart failure ...

Anabolic Deficiencies in Heart Failure

Heart Failure Clinics, 2020

Many patients with chronic heart failure show some hormonal deficiency that might worsen morbidity and mortality. Chronic heart failure development might be explained by the imbalance between catabolic and anabolic pathways present in the disease. Multiple hormonal deficiency is associated with a relevant worsening of prognosis in patients with chronic heart failure and patients should be screened for it. Replacement hormonal therapy in patients with chronic heart failure has shown promising beneficial results.