Long-term cardiometabolic outcome in patients with pituitary adenoma diagnosed in chilhood and adolescence

Giovinazzo, Salvatore; Puglisi, Soraya; Cotta, Oana Ruxandra; Alibrandi, Angela; Aversa, Tommaso; Cannavò, Laura; Ferraú, Francesco; Cannavò, Salvatore

doi:10.1007/s11102-020-01123-2

Cited by 6 publications

(4 citation statements)

References 26 publications

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“…The reasons for the significant difference in BMI observed between these two groups are not fully understood. In a recent study, the prevalence of overweight and obesity among young pituitary tumour patients (26.7% and 15.8%, respectively) was slightly lower than reported in our cohort, and was found to be similar to the unselected young population in South Italy, except for patients affected by GH-or ACTH-secreting tumours [21]. Sex-based analysis showed that headache and visual defects were significantly more frequent in males than in females only in the Group A, most likely due to the higher prevalence of larger lesion in males than females.…”

Section: Discussioncontrasting

confidence: 49%

“…Macro-tumours appear to be less frequent than in the adult population, most likely due to the early onset of clinical manifestations associated with hormonal hypersecretion, particularly hyperprolactinaemia, whereas in adults, pituitary tumours are more likely diagnosed because of mass effect symptoms [ 19 ]. Nonetheless, GH-secreting tumours are usually diagnosed as macro-tumours [ 20 , 21 ]—up to 96% in our cohort—and they may be more difficult to treat than in adults [ 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

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Sellar and parasellar lesions in the transition age: a retrospective Italian multi-centre study

Feola

Pirchio

Puliani

et al. 2022

J Endocrinol Invest

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Background Sellar/parasellar lesions have been studied in the adult and paediatric age range, but during the transition age their epidemiology, clinical manifestations, management and treatment outcomes have been poorly investigated. Materials and methods An Italian multicentre cohort study, in which hospital records of patients with diagnosis of sellar/parasellar lesions during the transition age and young adulthood (15–25 years), were reviewed in terms of prevalence, clinical and hormonal features at diagnosis, and outcomes where available. Both pituitary neuroendocrine tumours (pituitary tumours, Group A) and non-endocrine lesions (Group B) were included. Results Among Group A (n = 170, 46.5% macroadenomas), the most frequent were prolactin and GH-secreting tumours, with a female predominance. Among Group B (n = 28), germinomas and Rathke cells cysts were the most common. In Group A, the most frequent hormonal deficiency was gonadal dysfunction. Galactorrhoea and amenorrhoea were relatively common in female patients with prolactinomas. Pre-surgical diabetes insipidus was only seen in Group B, in which also hormone deficiencies were more frequent and numerous. Larger lesions were more likely to be seen in Group B. Patients in Group B were more frequently male, younger, and leaner than those of Group A, whereas at last follow-up they showed more obesity and dyslipidaemia. In our cohort, the percentage of patients with at least one pituitary deficiency increased slightly after surgery. Conclusions The management of sellar/parasellar lesions is challenging in the transition age, requiring an integrated and multidisciplinary approach. Hormone and metabolic disorders can occur many years after treatment, therefore long-term follow-up is mandatory.

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Section: Discussioncontrasting

confidence: 49%

Section: Discussionmentioning

confidence: 99%

Sellar and parasellar lesions in the transition age: a retrospective Italian multi-centre study

Feola

Pirchio

Puliani

et al. 2022

J Endocrinol Invest

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“…Two factors were related to reaching a normal weight: BMI z-score at diagnosis and BMI z-score change at 6 ±2 months [28]. Giovinazzo et al [29] revealed that in the cured patients, BMI was significantly lower than at baseline (SD 1.46 ±1.09 vs. 0.39 ±1.07, p = 0.031); however, there was no difference in BMI among the patients with the persistent dis-ease during follow-up [29]. In the research of Yordanowa et al [30] among the 21 patients, BMI SDS was lower at the latest assessment (mean 0.58; from −1.9 to -2.71), compared to diagnosis mean BMI SDS 2.9 (0.1-6.9) (p = 0.000).…”

Section: Discussionmentioning

confidence: 99%

Metabolic status in children with Cushing’s disease and its relationship with remission

Moszczyńska¹,

Baszyńska-Wilk²,

Bogusz-Wójcik³

et al. 2023

pedm

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Introduction: Complications of Cushing disease (CD), like diabetes and lipid disturbances, are the risk factors for higher morbidity and mortality.The study aimed to compare the metabolic status of patients with CD with obese children and assessed the impact of remission on metabolic consequences. Material and methods: This retrospective study analyzed 32 patients (aged 5 to 17 years) with CD. We evaluated anthropometric data and laboratory parameters -cholesterol fractions, glucose, and insulin levels in an oral glucose tolerance test (OGTT). Results were obtained at the moment of diagnosis and after transsphenoidal pituitary surgery (TSS), leading to remission. The data were compared with the age-matched and body mass index-matched control groups. Results: At diagnosis, 40% of patients had impaired glucose tolerance (IGT), 6.7% diabetes (DM), and 3% impaired fasting glucose (IFG). In the lipids profile, 81% of patients presented elevated total cholesterol (TC), 66.7% low-density lipoprotein (LDL-c), and 64% triglycerides (TG). After TSS, we detected only one child with IGT. Patients had lower glucose levels in 0 minutes ('), 30', 90',120', insulin levels in 0', 30', and 90' of OGTT, and lower TC and LDL-c than before TSS. There were statistically significant differences between the study and the control group in insulin levels at all-time points of the OGTT, fasting glucose levels, and 90' of the test. TC, LDL-c, and TG were statistically higher in the CD group. Conclusions: Remission significantly impacts improving metabolic parameters. Patients with CD require a higher insulin level to maintain normoglycemia than patients with obesity.

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“…Moreover, the detrimental effect of PRL excess on BMI has also been demonstrated to be a common finding in young patients with prolactinoma onset during childhood since a prevalence of obesity of about 35% has been reported at diagnosis at this age (65,66). Of note, bearing a prolactinoma in childhood could negatively affect metabolic health even during adulthood since obesity has been demonstrated to persist following treatment (65,66), even when the patient is cured (66).…”

Section: Effects On Food Intake and Body Weightmentioning

confidence: 99%

Metabolic effects of prolactin

et al. 2022

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Over the last years, the metabolic role of PRL has emerged. PRL excess is known to promote weight gain, obesity, metabolic syndrome, and impairment in gluco-insulinemic and lipid profiles, likely due to the suppression of physiologic dopaminergic tone. Prolactin receptors and dopamine receptors type 2 have been demonstrated to be expressed on both human pancreatic β- cell and adipocytes, supporting a key role of prolactin and dopamine in peripheral metabolic regulation. Medical treatment with the dopamine agonists bromocriptine and cabergoline has been demonstrated to decrease the prevalence of metabolic syndrome and obesity, and significantly improve gluco-insulinemic and lipid profiles. In hyperprolactinemic men with concomitant hypogonadism, correction of hyperprolactinaemia and testosterone replacement has been proven to restore metabolic impairment. In turn, low prolactin levels have also been demonstrated to exert a detrimental effect on weight gain, glucose and lipid metabolism, thus leading to an increased prevalence of metabolic syndrome. Therefore, PRL values ranging from 25 to 100 mg/L, in absence of other recognizable pathological causes, have been proposed to represent a physiological response to the request for an increase in metabolic activity, and nowadays classify the so-called HomeoFIT- PRL as a promoter of metabolic homeostasis. The current review focuses mainly on the effects of hyperprolactinemia and its control by medical treatment with DAs on the modulation of food intake, body weight, gluco-insulinemic and lipid profile. Furthermore, it provides the latest knowledge about the metabolic impact of hypoprolactinemia.

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Long-term cardiometabolic outcome in patients with pituitary adenoma diagnosed in chilhood and adolescence

Cited by 6 publications

References 26 publications

Sellar and parasellar lesions in the transition age: a retrospective Italian multi-centre study

Sellar and parasellar lesions in the transition age: a retrospective Italian multi-centre study

Metabolic status in children with Cushing’s disease and its relationship with remission

Metabolic effects of prolactin

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