Hypopituitarism and anemia: effect of replacement therapy with hydrocortisone and/or levothyroxine.

Although common, anemia associated with hypopituitarism has received little attention. We conducted a retrospective study to elucidate the effect of replacement therapy with hydrocortisone and/or levothyroxine on the decreased hemoglobin (Hb) level. A total of 68 patients who had been suffering from anterior pituitary deficiencies for more than 12 months were studied. The Hb level was significantly lower in patients with hypopituitarism (p=0.0012). Decreased Hb level (<12.0 g/dl) was observed in 22 patients (32.4%). It was related to hypocortisolism (regression weights=0.39), hypothyroidism (0.37), GHD (0.32) and hypogonadism in men (0.17). Among 68 patients, 30 patients had been receiving replacement therapy for at least 12 months. Hydrocortisone and levothyroxine increased the Hb level in 20 patients whose data were available before the replacement (p=0.0002). However, the Hb level was still lower in 30 patients receiving the replacement (p=0.0001). In 13 patients (8 men) with decreased Hb level (<12.0 g/dl) despite the replacement, GH and testosterone were deficient in 12 (92.3%) and 8 (100%) patients, respectively. In conclusion, replacement therapy with hydrocortisone and/or levothyroxine is effective in most patients but is not sufficient, at least in some patients, to improve the decreased Hb level. These results suggest that additional replacement therapy, i.e. with GH and/or androgen, is necessary to obtain further improvement.