ENDOCRINE OBESITY: Pituitary dysfunction in obesity

Ruiz, Sabina; Vázquez, Federico; Pellitero, Sílvia; Domingo, Manuel Puig

doi:10.1530/eje-21-0899

Cited by 10 publications

(8 citation statements)

References 121 publications

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“…Several endocrinological alterations have been described in patients with obesity, including a decrease in growth hormone (GH) and insulin-like growth factor (IGF-1) levels [ 5 , 6 ], hypogonadism [ 7 ], and an increase in thyroid-stimulating hormone (TSH) levels [ 8 ]. All hypothalamic–pituitary axes can be affected by obesity [ 9 ]. Despite this, the pituitary morphology in such patients is understudied.…”

Section: Introductionmentioning

confidence: 99%

Pituitary T1 signal intensity at magnetic resonance imaging is reduced in patients with obesity: results from the CHIASM study

et al. 2023

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Background Despite obesity being well known to be associated with several pituitary hormone imbalances, pituitary appearance in magnetic resonance imaging (MRI) in patients with obesity is understudied. Objective To evaluate the pituitary volume and signal intensity at MRI in patients with obesity. Methods This is a prospective study performed in an endocrine Italian referral center (ClinicalTrial.gov Identifier: NCT03458533). Sixty-nine patients with obesity (BMI > 30 kg/m2) and twenty-five subjects without obesity were enrolled. Thirty-three patients with obesity were re-evaluated after 3 years of diet and lifestyle changes, of whom 17 (51.5%) achieved a > 5% loss of their initial body weight, whereas the remaining 16 (48.5%) had maintained or gained weight. Evaluations included metabolic and hormone assessments, DEXA scan, and pituitary MRI. Pituitary signal intensity was quantified by measuring the pixel density using ImageJ software. Results At baseline, no difference in pituitary volume was observed between the obese and non-obese cohorts. At the 3-year follow-up, pituitary volume was significantly reduced (p = 0.011) only in participants with stable-increased body weight. Furthermore, a significant difference was noted in the mean pituitary intensity of T1-weighted plain and contrast-enhanced sequences between the obese and non-obese cohorts at baseline (p = 0.006; p = 0.002), and a significant decrease in signal intensity was observed in the subgroup of participants who had not lost weight (p = 0.012; p = 0.017). Insulin-like growth factor-1 levels, following correction for BMI, were correlated with pituitary volume (p = 0.001) and intensity (p = 0.049), whereas morning cortisol levels were correlated with pituitary intensity (p = 0.007). The T1-weighted pituitary intensity was negatively correlated with truncal fat (p = 0.006) and fibrinogen (p = 0.018). Conclusions The CHIASM study describes a quantitative reduction in pituitary intensity in T1-weighted sequences in patients with obesity. These alterations could be explained by changes in the pituitary stromal tissue, correlated with low-grade inflammation.

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Section: Introductionmentioning

confidence: 99%

Pituitary T1 signal intensity at magnetic resonance imaging is reduced in patients with obesity: results from the CHIASM study

et al. 2023

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“…The on-treatment data challenge the concept that TSH elevations in PCOS relate primarily to androgen excess [18] or body weight [19, 25, 26] given that the tested treatments had virtually parallel effects on androgenemia and body weight while having markedly divergent effects on TSH, insulin resistance, and ectopic fat. The posttreatment data in PCOS patients strengthen the notion that SPIOMET has the capacity to confer broadly normalizing benefits that persist beyond its intake and that are herewith extended to include a lowering of TSH concentrations into the safest preconception range.…”

Section: Discussionmentioning

confidence: 99%

“…The present pre-, on-, and posttreatment observations corroborate the hypothesis that a TSH elevation in an adolescent girl with PCOS may in essence be no more than an epiphenomenon that points to the presence of insulin resistance within a context of lipid accumulation in ectopic depots. TSH elevations have previously been described as epiphenomena of insulin resistance and/or ectopic fat in a variety of study populations including overweight children and adolescents and also nonobese and obese women with PCOS [18‒21, 24‒31].…”

Section: Discussionmentioning

confidence: 99%

Raised Thyroid-Stimulating Hormone in Girls with Polycystic Ovary Syndrome: Effects of Randomized Interventions

Garcia-Beltran

Bassols²,

Carreras‐Badosa

et al. 2023

Horm Res Paediatr

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Introduction Polycystic ovary syndrome (PCOS) in women associates with raised levels of circulating thyroid stimulating hormone (TSH) and with high rates of gestational complications. A low range of preconception TSH is followed by low rates of gestational complications. It is unknown whether TSH levels are elevated in adolescents with PCOS and, if so, whether traditional or exploratory treatments can lower them into safe preconception range. We investigated TSH in non-obese adolescents with PCOS, including the effects of randomized interventions. Methods Morning TSH was a safety marker in randomized pilot studies comparing the effects of an oral contraceptive (OC) versus those of a low-dose combination of spironolactone-pioglitazone-metformin (SPIOMET) in non-obese adolescents with PCOS. A post-hoc analysis compared: TSH levels in PCOS (N= 62) vs controls; TSH changes on treatment (for 1 year); TSH levels post treatment (for 1 year). Results Mean TSH levels were higher in PCOS patients than in control girls (P<0.01). On-treatment TSH levels diverged (P<0.001), remaining elevated on OC, and descending swiftly on SPIOMET, well into safe preconception range. Post-treatment TSH levels were stable in both subgroups. On-treatment changes of circulating TSH associated to those of liver fat (R= 0.307, P= 0.017). Conclusion The endocrine signature of early PCOS is herewith extended to include modestly raised levels of circulating TSH; the normalizing effects of SPIOMET intervention in non-obese adolescents with PCOS are herewith extended to include on- and post-treatment TSH.

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“…The underlying causal association between TSH and obesity remains unclear ( 8 ), although obesity seems to be the cause of the rise in TSH serum levels ( 10 ). Some studies have observed a relationship between ectopic liver fat accumulation and TSH levels in adults ( 18 ).…”

Section: Discussionmentioning

confidence: 99%

“…Circulating T4 was inversely associated with components of the metabolic syndrome in adults ( 5 ) and inversely associated with insulin resistance and visceral fat accumulation in children ( 7 ). Several epidemiological studies have investigated the association between thyroid-stimulating hormone (TSH) and obesity ( 8 ). As opposed to T4, TSH levels have been directly associated with waist circumference in adults ( 9 ), and it is known that an increase in body mass index (BMI), progressive central fat accumulation, and/or genetically driven BMI can cause an elevation of serum TSH ( 10 ), ( 11 ).…”

Section: Introductionmentioning

confidence: 99%

Circulating free T3 associates longitudinally with cardio-metabolic risk factors in euthyroid children with higher TSH

Carreras-Badosa,

Puerto-Carranza,

Mas-Parés

et al. 2023

Front. Endocrinol.

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IntroductionThyroid hormones play major roles in the regulation of body composition and metabolism, and therefore, the relationship between thyroid hormones and cardio-metabolic risk has been extensively studied in adults. In this study, we aimed to test whether free triiodothyronine (fT3) associates longitudinally with cardio-metabolic risk factors in euthyroid children.MethodsA prospective study cohort of 599 apparently healthy school-age children were assessed at baseline (mean age 8.1 ± 2.1 years), of whom 270 children were also assessed at follow-up (4 years later). Circulating thyroid-stimulating hormone (TSH), free thyroxine (fT4), and fT3 were measured, and cardio-metabolic risk was assessed by means of body mass index (BMI), waist circumference, visceral fat (by ultrasound), blood pressure, circulating lipids, and homeostasis model assessment of insulin resistance (HOMA-IR) index, both at baseline and at follow-up.ResultsAll studied children had normal thyroid function tests. Independent associations between baseline fT3 and both baseline and follow-up BMI, systolic blood pressure, mean arterial blood pressure, triglycerides, and HOMA-IR were found using multivariate regression analysis (adjusting for sex and baseline age and BMI). Analyses of effect sizes showed that for each 1 unit-increase in baseline fT3 (pg/ml), follow-up BMI–standard deviation score (SDS) increased by 0.31 units (z-score) and systolic blood pressure by 6.6 units (mmHg). The observed longitudinal associations were more robust in children belonging to the upper TSH tertile who showed higher TSH levels and were characterized by weighing more and having the highest fT3 levels. In these children, for each 1 unit-increase in baseline fT3 (pg/ml), follow-up BMI-SDS increased by 0.67 units (z-score) and systolic blood pressure by 10.2 units (mmHg).ConclusionsCirculating fT3 associates longitudinally with cardio-metabolic risk factors in euthyroid children with higher TSH. The observed associations of thyroid hormones in these children could conceivably respond to a homeostatic attempt to reduce their cardio-metabolic risk.

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ENDOCRINE OBESITY: Pituitary dysfunction in obesity

Cited by 10 publications

References 121 publications

Pituitary T1 signal intensity at magnetic resonance imaging is reduced in patients with obesity: results from the CHIASM study

Pituitary T1 signal intensity at magnetic resonance imaging is reduced in patients with obesity: results from the CHIASM study

Raised Thyroid-Stimulating Hormone in Girls with Polycystic Ovary Syndrome: Effects of Randomized Interventions

Circulating free T3 associates longitudinally with cardio-metabolic risk factors in euthyroid children with higher TSH

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