What are the risks of hormonal overreplacement in hypopituitarism?
Excessive glucocorticoid doses in patients with central adrenal insufficiency can cause weight gain, metabolic syndrome, increased overall and cardiovascular mortality, bone loss, and, especially in men, increased vertebral fracture risk despite the restoration of gonadal status. Low-dose hydrocortisone replacement may actually increase bone formation and promote a positive bone-remodeling balance. LT 4 overreplacement in central hypothyroidism increases the risk of atrial fibrillation, increases overall and cardiovascular-specific mortality and morbidity, and promotes bone turnover, resulting in an increased fracture risk, mainly in postmenopausal women. Higher LT 4 doses have been associated with a higher prevalence of vertebral fractures. The overall impact of estrogen and testosterone replacement on cardiovascular disease in patients with central hypogonadism is unclear. Estrogen replacement therapy through age 50 years may reduce the risk of cardiovascular disease and mortality.