Abstract
ObjectivePatients treated for nonfunctioning pituitary macroadenoma (NFMA) with suprasellar extension show disturbed sleep characteristics, possibly related to hypothalamic dysfunction. In addition to hypopituitarism, both structural hypothalamic damage and sleep restriction per se are associated with the metabolic syndrome. However, the prevalence of the metabolic syndrome in patients with NFMA is not well established. Our objective was to study the prevalence and risk factors for (components of) the metabolic syndrome in patients treated for NFMA.DesignThe metabolic syndrome (NCEP-ATP III criteria) was studied in an unselected cohort of 145 NFMA patients (aged 26–88yr, 44% female) in long-term remission after treatment, receiving adequate stable hormone replacement for any pituitary deficiencies. The results were compared to population data of 63,995 Dutch inhabitants by standardization (LifeLines cohort study).ResultsNFMA patients showed increased risk for reduced HDL-cholesterol (SMR 1.59, 95% CI 1.13–2.11), increased triglyceride levels (SMR 2.31, 95% CI 1.78–2.90) and the metabolic syndrome (SMR 1.60, 95% CI 1.22–2.02), but not for increased blood pressure, waist circumference or hyperglycemia. Preoperative visual field defects independently affected the risk for increased blood pressure (OR 6.5, 95% CI 1.9–22.2), and hypopituitarism was associated with a body mass index - dependent risk for increased waist circumference (OR 1.6, 95% CI 1.2–2.2) and the metabolic syndrome (OR 1.4, 95% CI 1.0–1.9).ConclusionsPatients treated for NFMA are increased at risk for developing the metabolic syndrome, mainly due to decreased HDL-cholesterol and increased triglycerides. Risk factors included hypopituitarism and preoperative visual field defects. Hypothalamic dysfunction may explain the metabolic abnormalities, in addition to intrinsic imperfections of hormone replacement therapy. Additional research is required to explore the relation between derangements in circadian rhythmicity and metabolic syndrome in these patients.
Highlights
Nonfunctioning pituitary macroadenomas (NFMA, adenoma .10 mm) comprise approximately 25% of clinically relevant pituitary adenomas [1], and often present with pituitary insufficiency and visual field defects (VFD) due to compression of the optic chiasm
Preoperative visual field defects independently affected the risk for increased blood pressure, and hypopituitarism was associated with a body mass index dependent risk for increased waist circumference and the metabolic syndrome
Patients treated for nonfunctioning pituitary macroadenoma (NFMA) are increased at risk for developing the metabolic syndrome, mainly due to decreased HDL-cholesterol and increased triglycerides
Summary
Nonfunctioning pituitary macroadenomas (NFMA, adenoma .10 mm) comprise approximately 25% of clinically relevant pituitary adenomas [1], and often present with pituitary insufficiency and visual field defects (VFD) due to compression of the optic chiasm. Transsphenoidal surgery is the treatment of choice, resulting in improvement of visual function in the majority of patients [2]. In follow-up, a high prevalence of hypopituitarism remains present in NFMA patients. We have shown that patients successfully treated for NFMA suffer from disturbances in sleep characteristics, circadian movement rhythm, and subjective sleep quality [4], the cause of which remains to be elucidated. In view of the close anatomical relationship between the optic chiasm and the hypothalamus, it is possible that impaired function of the suprachiasmatic nucleus (SCN) of the hypothalamus, the main director of circadian rhythmicity, might cause these symptoms
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