Medicina, Vol. 59 No. 2, 2023.
Studija slučaja
https://doi.org/10.21860/medflum2023_300578
The Treatment of Hypercholesterolemia in a Patient with Panhypopituitarism and Familial Hypercholesterolemia: A Case Report
Nikolina Morić
orcid.org/0009-0005-1898-4196
; Sveučilište u Rijeci, Medicinski fakultet, Rijeka, Hrvatska
Alen Omerović
orcid.org/0009-0002-3543-7651
; Sveučilište u Rijeci, Medicinski fakultet, Rijeka, Hrvatska
Maja Mrak
orcid.org/0000-0001-7175-6399
; Sveučilište u Rijeci, Medicinski fakultet, Rijeka, Hrvatska
Gorana Mirošević
; Klinički bolnički centar „Sestre milosrdnice”, Zavod za endokrinologiju, dijabetes i bolesti metabolizma, Zagreb, Hrvatska; Sveučilište u Zagrebu, Stomatološki fakultet, Zagreb, Hrvatska
Dario Rahelić
; Klinička bolnica Merkur, Sveučilišna klinika za dijabetes, endokrinologiju i bolesti metabolizma Vuk Vrhovac, Zagreb, Hrvatska; Hrvatsko katoličko sveučilište, Medicinski fakultet, Zagreb, Hrvatska; Sveučilište Josipa Jurja Strossmayera u Osijeku, Medicinski fakultet, Osijek, Hrvatska
Sanja Klobučar
orcid.org/0000-0002-0287-4735
; Sveučilište u Rijeci, Medicinski fakultet, Rijeka, Hrvatska; Klinički bolnički centar Rijeka, Zavod za endokrinologiju, dijabetes i bolesti metabolizma, Rijeka, Hrvatska
Sažetak
Aim: To present a patient with FH (familial hypercholesterolemia) and panhypopituitarism in whom, despite triple hypolipidemic therapy, the target LDL cholesterol was approximately reached only after the introduction of somatotropin replacement therapy, which is not otherwise necessary for adults with panhypopituitarism. Case report: A 54-year-old patient was referred for endocrinological evaluation at the Rijeka Clinical Hospital. In 2005, the patient underwent percutaneous coronary intervention with stent placement in the right coronary artery, endovascular treatment of femoral artery stenosis, he also suffers from arterial hypertension, dyslipidemia, type 2 diabetes and grade 3 obesity (BMI 43.5 kg/m2). In the treatment of erectile dysfunction and polyuria in 2018, panhypopituitarism was established. The patient regularly took the recommended hormone replacement therapy (hydrocortisone, levothyroxine, desmopressin, testosterone undecanoate) in addition to chronic therapy (metformin, fenofibrate, atorvastatin, ezetimibe, clopidogrel, nebivolol, lercanidipine). Despite the maximum dose of high-potency statin and ezetimibe, markedly elevated levels of LDL cholesterol (8.0 mmol/L), total cholesterol (10.5 mmol/L), triglycerides (3.8 mmol/L) and decreased HDL cholesterol (0.6 mmol/L) were found. Given the anamnestic data, laboratory findings and the Duch Lipid Clinical Network scoring system, which was 12, the diagnosis of familial hypercholesterolemia was very likely and, in addition to current hypolipemia therapy, the treatment with PCSK-9 inhibitor was recommended. Three months after the introduction of PCSK9i into therapy, LDL cholesterol (2.3), total cholesterol (4.0) and triglycerides (1.8) were significantly reduced, and HDL values (0.9) increased. Given the presumed beneficial effect of growth hormone replacement therapy, somatotropin was recommended, which the patient took in the course of further treatment, and the LDL value was further reduced at the next follow-up examination (1.6), with a beneficial effect on other lipid parameters. (total cholesterol 3.5, triglycerides 2.5, HDL 0.8, non-HDL 2.7). Conclusion: There are few studies that deal with the relationship between growth hormone replacement therapy and dyslipidemia, and triple hypolipidemic therapy is recommended in the treatment of dyslipidemia. In our patient, who has FH and panhypopituitarism, the use of a combination of statins, ezetimibe, PCSK9i and somatotropin has almost reached the target values of LDL, which may suggest that further research is needed in this area to define therapeutic guidelines.
Ključne riječi
Growth Hormone; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Hyperlipoproteinemia Type II; Hypopituitarism; PCSK9 Inhibitors
Hrčak ID:
300578
URI
Datum izdavanja:
1.6.2023.
Posjeta: 684 *