Abstract
Context An elevated incidence of type 2 diabetes and cardiovascular disease (CVD) has been reported in patients with nonfunctional pituitary macroadenoma (NFPMA). There is no information about metabolic syndrome and cardiovascular risk in patients with NFPMA in our population. Objective Analyze the metabolic syndrome (MetS) components and estimate cardiovascular risk in patients with NFPMA. Design and Setting Retrospective study, at the tertiary care center. Patients and Methods 71 patients with NFPMA treated according to a preestablished multimodal protocol. Main Outcome Measures Prevalence of diabetes, hypertension, high cholesterol, obesity, and cardiovascular risk and its relationship with the clinical and biochemical characteristics. Results The prevalence of diabetes, hypertension, high cholesterol, and obesity at diagnosis was 30%, 27%, 48%, and 85% and did not change upon the last visit. The prevalence of MetS changes from 54 to 48% (p = 0.001). NFPMA patients showed a significant increase risk for high total cholesterol (SMR 1.68, 95% CI 1.28–2.17, p = 0.001) and diabetes (SMR 3.19, 95% CI 2.19–4.49, p = 0.01). According to Globorisk, the male gender was an evidence of high CVD before (81% versus 18%, p = 0.01) and after (72% versus 28%, p = 0.01) multimodal treatment. Conclusion A high prevalence of cardiovascular and metabolic disease and a high cardiovascular risk were evidenced in patients with NFPMA, especially in men. Risk factors such as the personal history of hypertension and dyslipidemia could explain the foregoing, so the control and treatment of metabolic parameters and cardiovascular risk should be an integral part of the follow-up of these patients.
Highlights
Nonfunctional pituitary macroadenoma (NFPMA) is a benign lesion of the pituitary gland with a diameter larger than 1 cm, which represents approximately 30% of all pituitary tumors
cardiovascular disease (CVD) can be related to hypopituitarism and imperfections of hormone replacement strategies, sleep-wake cycle alterations, circadian rhythm dysregulation, and obesity related to hypothalamic dysfunction, all of these being associated with lesion or destruction of the hypothalamic nucleus in large suprasellar lesions [6,7,8,9]
metabolic syndrome (MetS) was defined according to the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III), and patients are said to have MetS if they have three or more of the following: Waist circumference (WC) greater than 102 cm in men and 88 cm in women, blood pressure higher than 130/85 mmHg or antihypertensive drug medication, fasting triglycerides higher than 150 mg/dL, high-density lipoprotein cholesterol (HDL-C) less than 40 mg/dL in men and 50 mg/dL in women or a previously treated dyslipidemia, and fasting glucose over 100 mg/dL or diabetes treatment [10]
Summary
Nonfunctional pituitary macroadenoma (NFPMA) is a benign lesion of the pituitary gland with a diameter larger than 1 cm, which represents approximately 30% of all pituitary tumors. NFPMA do not secrete pituitary hormones that leads to a clinical syndrome; they are related to headache, visual field defects with or without decreased visual acuity (mass effects of the tumor), and hypopituitarism. An elevated incidence of type 2 diabetes and CVD, such as acute myocardial infarction and cerebral stroke, has been reported in patients with NFPMA [2,3,4,5]. CVD can be related to hypopituitarism and imperfections of hormone replacement strategies, sleep-wake cycle alterations, circadian rhythm dysregulation, and obesity related to hypothalamic dysfunction, all of these being associated with lesion or destruction of the hypothalamic nucleus in large suprasellar lesions [6,7,8,9].
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