Abstract

Aim: The risk of ischemic stroke is increased 5-fold in patients with atrial fibrillation (the most common reason for cardiac arrhythmia). The aim is to investigate whether insufficiency in anterior pituitary hormones develops in patients diagnosed with atrial fibrillation and no history of cerebrovascular accident.

Method: A group of 65 patients with chronic /paroxysmal atrial fibrillation without a history of cerebrovascular accident and a group of 65 healthy controls without arrhythmia were included in this study. Atrial fibrillation was diagnosed by electrocardiography or 24-hour rhythm holter. Demographic data, biochemical tests, echocardiography findings were compared between the groups. P<0.05 was considered statistically significant.

Results: There was no statistical difference in gender and age distribution between groups (p<0.05). (Patient group: Mean age 68 ± 7 years (16 (24.6%) male and 49 (75.4%) female) / Control group: Mean age 67 ± 6 years (18 (27.7%) male and 47 (72.3%) female). Serum insulin-like growth factor-1, adrenocorticotropic hormone and cortisol levels were significantly lower in the patient group compared to the control group (p=0.048, p=0.005, p=0.023). There was no significant difference in serum thyroid-stimulating hormone, follicle-stimulating hormone, luteinizing hormone, and prolactin levels between groups. Left atrial diameter and left ventricular end-diastolic diameter were higher in the patient group (p<0.0001). The left ventricular ejection fraction value was lower in the patient group (p<0.0001).

Conclusion: It was thought that the reason for the low level of insulin-like growth factor-1 in the setting of normal liver and kidney functions and simultaneous cortisol and adrenocorticotropic hormone deficiency, in patients with atrial fibrillation with no history of cerebrovascular accident might be due to silent cerebral ischemia leading to pituitary dysfunction.

Keywords: Anterior pituitary hormones, atrial fibrillation, embolism

Copyright and license

Copyright © 2024 The Author(s). This is an open-access article published by Bolu İzzet Baysal Training and Research Hospital under the terms of the Creative Commons Attribution License (CC BY) which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

How to cite

1.
Köse Çobanoğlu R, Ertuğrul DT, Yavuz B, Beyan E. Evaluation of anterior pituitary hormone levels in patients with atrial fibrillation. Northwestern Med J. 2024;4(4):206-12. https://doi.org/10.54307/2024.NWMJ.105

References

  1. European Heart Rhythm Association; European Association for Cardio-Thoracic Surgery, Camm AJ, et al. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J. 2010; 31(19): 2369-429. https://doi.org/10.1093/eurheartj/ehq278
  2. Kalantarian S, Ay H, Gollub RL, et al. Association between atrial fibrillation and silent cerebral infarctions: a systematic review and meta-analysis. Ann Intern Med. 2014; 161(9): 650-8. https://doi.org/10.7326/M14-0538
  3. Kannel WB, Wolf PA, Benjamin EJ, Levy D. Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation: population-based estimates. Am J Cardiol. 1998; 82(Suppl 1): 2N-9N. https://doi.org/10.1016/s0002-9149(98)00583-9
  4. Akdemir İ, Dağdelen S, Çelik Ş, et al. Romatizmal mitral darlığı olan hastalarda sessiz beyin infarktı sıklığı. Türk Kardiyol Dern Arş. 2000; 28: 673-77.
  5. Feinberg WM, Seeger JF, Carmody RF, Anderson DC, Hart RG, Pearce LA. Epidemiologic features of asymptomatic cerebral infarction in patients with nonvalvular atrial fibrillation. Arch Intern Med. 1990; 150(11): 2340-4.
  6. Kannel WB, Benjamin EJ. Current perceptions of the epidemiology of atrial fibrillation. Cardiol Clin. 2009; 27(1): 13-24. https://doi.org/10.1016/j.ccl.2008.09.015
  7. Busch M, Krüger A, Gross S, et al. Relation of IGF-1 and IGFBP-3 with prevalent and incident atrial fibrillation in a population-based study. Heart Rhythm. 2019; 16(9): 1314-9. https://doi.org/10.1016/j.hrthm.2019.03.017
  8. Duron E, Vidal JS, Funalot B, et al. Insulin-like growth factor I, insulin-like growth factor binding protein 3, and atrial fibrillation in the elderly. J Gerontol A Biol Sci Med Sci. 2014; 69(8): 1025-32. https://doi.org/10.1093/gerona/glt206
  9. Larsson SC, Lee WH, Burgess S, Allara E. Plasma Cortisol and Risk of Atrial Fibrillation: A Mendelian Randomization Study. J Clin Endocrinol Metab. 2021; 106(7): e2521-6. https://doi.org/10.1210/clinem/dgab219
  10. Kumral E, Balkir K, Uzuner N, Evyapan D, Nalbantgil S. Microembolic signal detection in patients with symptomatic and asymptomatic lone atrial fibrillation. Cerebrovasc Dis. 2001; 12(3): 192-6. https://doi.org/10.1159/000047703
  11. Zito M, Muscari A, Marini E, Di Iorio A, Puddu GM, Abate G. Silent lacunar infarcts in elderly patients with chronic non valvular atrial fibrillation. Aging (Milano). 1996; 8(5): 341-6. https://doi.org/10.1007/BF03339591
  12. Tinkler K, Cullinane M, Kaposzta Z, Markus HS. Asymptomatic embolisation in non-valvular atrial fibrillation and its relationship to anticoagulation therapy. Eur J Ultrasound. 2002; 15(1-2): 21-7. https://doi.org/10.1016/s0929-8266(01)00169-0
  13. Boehncke S, Ackermann H, Badenhoop K, Sitzer M. Pituitary function and IGF-I levels following ischemic stroke. Cerebrovasc Dis. 2011; 31(2): 163-9. https://doi.org/10.1159/000321738
  14. Chang AY, Abdullah SM, Jain T, et al. Associations among androgens, estrogens, and natriuretic peptides in young women: observations from the Dallas Heart Study. J Am Coll Cardiol. 2007; 49(1): 109-16. https://doi.org/10.1016/j.jacc.2006.10.040
  15. Saenger AK, Dalenberg DA, Bryant SC, Grebe SK, Jaffe AS. Pediatric brain natriuretic peptide concentrations vary with age and sex and appear to be modulated by testosterone. Clin Chem. 2009; 55(10): 1869-75. https://doi.org/10.1373/clinchem.2009.123778
  16. Lam CSP, Cheng S, Choong K, et al. Influence of sex and hormone status on circulating natriuretic peptides. J Am Coll Cardiol. 2011; 58(6): 618-26. https://doi.org/10.1016/j.jacc.2011.03.042
  17. Karabağ Y, Rencuzogullari I, Çağdaş M, et al. Association between BNP levels and new-onset atrial fibrillation: A propensity score approach. Herz. 2018; 43(6): 548-54. https://doi.org/10.1007/s00059-017-4598-6
  18. Zhou J, Yuan Y, Li X. The association between C-peptide and atrial cardiomyopathy in nondiabetic adults: results from NHANES III. Heart Vessels. 2023; 38(8): 1049-55. https://doi.org/10.1007/s00380-023-02259-4
  19. Fliers E, Bianco AC, Langouche L, Boelen A. Thyroid function in critically ill patients. Lancet Diabetes Endocrinol. 2015; 3(10): 816-25. https://doi.org/10.1016/S2213-8587(15)00225-9