Metabolic syndrome and its components in adult hypopituitary patients

Abe, Simone Yae; Santos, Kamila Souza Dos; Barbosa, Bruna Fernanda Battistuzzi; Biondo, Claudia Maria Perera; Takito, Debora; Hayashi, Shohei; Amarilla, Victor Galvani Vianna; Ulbrich, Anderson Zampier; Boguszewski, César Luiz

doi:10.1007/s11102-020-01048-w

Cited by 16 publications

(9 citation statements)

References 29 publications

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“…In patients with hypopituitarism who are not CBTS, the prevalence of obesity may be increased because of body fat accumulation caused by endocrine deficiencies. [28][29][30] Patients with pituitary tumors may be at increased risk for obesity, and inclusion of such patients in a childhood brain tumor cohort might mask the prevalence of weight changes of other patients with brain tumor.…”

Section: Introductionmentioning

confidence: 99%

High Prevalence of Weight Gain in Childhood Brain Tumor Survivors and Its Association With Hypothalamic-Pituitary Dysfunction

Schaik

Roessel

Meeteren

et al. 2021

JCO

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PURPOSE Childhood brain tumor survivors (CBTS) are at risk for developing obesity, which negatively influences cardiometabolic health. The prevalence of obesity in CBTS may have been overestimated in previous cohorts because of inclusion of children with craniopharyngioma. On the contrary, the degree of weight gain may have been underestimated because of exclusion of CBTS who experienced weight gain, but were neither overweight nor obese. Weight gain may be an indicator of underlying hypothalamic-pituitary (HP) dysfunction. We aimed to study prevalence of and risk factors for significant weight gain, overweight, or obesity, and its association with HP dysfunction in a national cohort of noncraniopharyngioma and nonpituitary CBTS. METHODS Prevalence of and risk factors for significant weight gain (body mass index [BMI] change ≥ +2.0 standard deviation score [SDS]), overweight, or obesity at follow-up, and its association with HP dysfunction were studied in a nationwide cohort of CBTS, diagnosed in a 10-year period (2002-2012), excluding all craniopharyngioma and pituitary tumors. RESULTS Of 661 CBTS, with a median age at follow-up of 7.3 years, 33.1% had significant weight gain, overweight, or obesity. Of the CBTS between 4 and 20 years of age, 28.7% were overweight or obese, compared with 13.2% of the general population between 4 and 20 years of age. BMI SDS at diagnosis, diagnosis of low-grade glioma, diabetes insipidus, and central precocious puberty were associated with weight gain, overweight, or obesity. The prevalence of HP dysfunction was higher in overweight and obese CTBS compared with normal-weight CBTS. CONCLUSION Overweight, obesity, and significant weight gain are prevalent in CBTS. An increase in BMI during follow-up may be a reflection of HP dysfunction, necessitating more intense endocrine surveillance.

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Section: Introductionmentioning

confidence: 99%

High Prevalence of Weight Gain in Childhood Brain Tumor Survivors and Its Association With Hypothalamic-Pituitary Dysfunction

Schaik

Roessel

Meeteren

et al. 2021

JCO

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“…Previous studies have reported a negative effect of hypopituitarism on metabolic profiles. The prevalence of MetS in adult patients with hypopituitarism has increased to 38-43.1% in association with higher cardiovascular and cerebrovascular morbidity (43,44). Joustra et al revealed that the number of pituitary axis deficiencies is related to the risk of MetS (45).…”

Section: Discussionmentioning

confidence: 99%

Metabolic syndrome as a common comorbidity in adults with hypothalamic dysfunction

Yuan

et al. 2022

Front. Endocrinol.

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ObjectiveHypothalamic dysfunction (HD) results in various endocrine disorders and is associated with an increased risk of metabolic comorbidities. This study aimed to analyze the clinical characteristics and metabolic abnormalities of adults with HD of various causes.MethodsThis study retrospectively reviewed adults with HD treated at our center between August 1989 and October 2020. Metabolic characteristics of patients were compared to those of age-, sex-matched lean, and body mass index (BMI)-matched controls.ResultsTemperature dysregulation (61.0%) was the most common hypothalamic physiological dysfunction. At least one anterior pituitary hormone deficiency was observed in 50 patients (84.7%), with hypogonadotropic hypogonadism being the most frequently observed. Metabolic syndrome was confirmed in 31 patients (52.5%) and was significantly more prevalent in those with panhypopituitarism or overweight/obesity. Metabolic syndrome (MetS) was significantly more common in patients with HD than in both lean and BMI-matched controls (P < 0.001 and P = 0.030, respectively). Considering the components of MetS, elevated fasting glucose levels were significantly more common in patients with HD than in BMI-matched controls (P = 0.029). Overweight/obesity and panhypopituitarism were significant risk factors for MetS in the multivariate analysis on patients with HD. Moreover, in the multivariate analysis on patients and BMI-matched control, HD was a significant risk factor of MetS (P=0.035, OR 2.919) after adjusted for age, sex and BMI.ConclusionsTemperature dysregulation and hypogonadotropic hypogonadism are the most common physiological and endocrine dysfunctions, respectively. MetS and unfavorable metabolic profiles were prevalent in adults with HD. HD was a significant risk factor of MetS after adjusted for BMI.

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“…Despite that, pituitary tumors and their treatment with surgery and/or radiotherapy account for up to two-thirds of the cases in most literature series. Indeed, in a recent single-center Brazilian study involving 99 adult patients with hypopituitarism, around half of the patients had nontumoral causes of hypopituitarism, while FSH/LH, GH, TSH, and ACTH deficiencies were present in 99%, 98.6%, 96%, and 81.8% of them, respectively (12). Of note, Sheehan's syndromenecrosis of the pituitary gland occurring during or soon after labor -continues to be a common cause of hypopituitarism in women in developing regions of the world (13).…”

Section: Etiologymentioning

confidence: 99%

“…Insulin sensitivity varies greatly among patients with hypopituitarism, depending on numerous factors such as the etiology and treatment of the underlying cause, obesity, severity of pituitary deficiency, and inadequate hormone replacement (31). Metabolic syndrome, as defined by the National Cholesterol Education Program (NCEP) Adult Treatment Panel III criteria, has been observed in roughly 40% of the adult patients with hypopituitarism, and is associated with an increased risk of diabetes and vascular events (12,(32)(33)(34).…”

Section: Clinical Manifestations Of Hypopituitarismmentioning

confidence: 99%

“…A detailed description of isolated congenital forms of HH is beyond the scope of this article (for a review on this topic, see Reference 63). Acquired HH is very common in patients with hypopituitarism due to pituitary adenomas and/or their treatment with surgery or radiotherapy, usually accompanied by other pituitary hormone deficiencies (12). Anorexia nervosa, excessive exercise, and psychological distress are common causes of acquired HH in women, and medications such as opiates, psychotropic agents, and glucocorticoids, can induce HH in both sexes.…”

Section: Hypogonadotropic Hypogonadism (Fsh/lh Deficiency)mentioning

confidence: 99%

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Management of hypopituitarism: a perspective from the Brazilian Society of Endocrinology and Metabolism

Garmes

Boguszewski

Miranda

et al. 2021

Archives of Endocrinology and Metabolism

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Hypopituitarism is a disorder characterized by insufficient secretion of one or more pituitary hormones. New etiologies of hypopituitarism have been recently described, including head trauma, cerebral hemorrhage, and drug-induced hypophysitis. The investigation of patients with these new disorders, in addition to advances in diagnosis and treatment of hypopituitarism, has increased the prevalence of this condition. Pituitary hormone deficiencies can induce significant clinical changes with consequent increased morbidity and mortality rates, while hormone replacement based on current guidelines protects these patients. In this review, we will first discuss the different etiologies of hypopituitarism and then address one by one the clinical aspects, diagnostic evaluation, and therapeutic options for deficiencies of TSH, ACTH, gonadotropin, and GH. Finally, we will detail the hormonal interactions that occur during replacement of pituitary hormones.

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Metabolic syndrome and its components in adult hypopituitary patients

Cited by 16 publications

References 29 publications

High Prevalence of Weight Gain in Childhood Brain Tumor Survivors and Its Association With Hypothalamic-Pituitary Dysfunction

High Prevalence of Weight Gain in Childhood Brain Tumor Survivors and Its Association With Hypothalamic-Pituitary Dysfunction

Metabolic syndrome as a common comorbidity in adults with hypothalamic dysfunction

Management of hypopituitarism: a perspective from the Brazilian Society of Endocrinology and Metabolism

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