Pituitary dysfunction in heart block: The need for broader insight

Sir,

I read with great interest the article by Laway et al¹ published in the June 2024 issue of the Indian Journal of Medical Research. While this study shows an important link between complete heart block (CHB) and anterior pituitary dysfunction, I would like to raise several points.

First, the study’s small cohort (n=30) limits the generalisability of its conclusion. With such a small cohort, it is difficult to conclude whether the observed hormonal dysfunctions are applicable to the general population¹.

Furthermore, confounding factors such as prior trauma, comorbidities, and the impact of medication have not been discussed. These factors could influence anterior pituitary hormone levels and should be accounted for in future studies².

Finally, the study shows an association, but does not mention the mechanism linking CHB with anterior pituitary dysfunction. Understanding the mechanism would greatly enhance the clinical significance of this study. Previous research shows that hypoperfusion of the hypothalamic-pituitary axis (HPA) can modify the function of HPA, which can lead to anterior pituitary dysfunction³.

Laway et al¹ presented a valuable study showing a link between anterior pituitary dysfunction and CHB. Nevertheless, a more detailed study with a larger cohort, which also describes the confounding factors and the mechanism linking CHB to anterior pituitary dysfunction, is needed.