Severe growth hormone deficiency and empty sella in obesity: a cross-sectional study

Abstract

Obesity is associated with blunted growth hormone (GH) secretion. In some individuals, hypothalamic-pituitary (HP) structural lesions may contribute to GH deficiency (GHD). We explored pituitary morphology in obese patients with suspected GHD and its association with cardiovascular risk factors, body composition, and cardiac morphology. One hundred and eighty-four adults obese patients with symptoms and signs of GHD (147 females and 37 males; mean age 46.31 ± 12.11 years), out of 906 consecutive white obese outpatients, were evaluated. The main measures were anthropometric data, blood pressure, lipid profile, glycemic parameters, pituitary hormones, and insulin-like growth factor-1 values, echocardiography, magnetic resonance imaging (MRI) of the HP region, body composition, and growth hormone-releasing hormone plus arginine test. Seventy patients had GHD (GH peak values <4.2 μg/mL). GHD patients showed significantly higher body mass index and fat mass, lower lumbar bone mineral density, increased left ventricular mass index, and epicardial fat thickness. The MRI of the HP region showed empty sella (ES) in 69 and normal pituitary in one of the 70 GHD patients; the 114 patients with normal GH response had ES (n = 62, 54 %), normal pituitary (n = 37, 32 %), microadenomas (n = 10, 8 %), and other pituitary abnormalities (n = 5, 4 %). ES was a significant independent predictor of GH secretory capacity as determined by multiple regression analysis. The close relationship between ES and GH secretory capacity points out to the possibility of the organic nature of GHD in a portion of obese individuals and opens a new scenario with regard to the potential of GH treatment on metabolic consequences of obesity.

Obesity and related consequences to ageing

“…Obesity is correlated with blunted GH secretion (Lubrano et al 2015). It has been proposed that in some patients with AGHD, a hypothalamic-pituitary structural lesion may contribute to GH deficiency (Lubrano et al 2015).…”

“…It has been proposed that in some patients with AGHD, a hypothalamic-pituitary structural lesion may contribute to GH deficiency (Lubrano et al 2015). The close relationship between empty sella (observed frequently in obese individuals) and GH secretory capacity indicates the possibility of AGHD being natural state in obese humans (Lubrano et al 2015).…”

Growth hormone peak modifies the effect of BMI on increased systolic blood pressure in children with short stature

“…Blood pressure (BP), especially systolic BP (SBP), was reported to be higher in AGHD patients than in normal controls 9,10 . However, these data were obtained from heterogeneous cohorts of adult patients with GHD of varying etiologies and durations.…”

Fatty Liver Index Associates with Relative Sarcopenia and GH/ IGF- 1 Status in Obese Subjects

“…Growth hormone (GH) and insulin- like growth factor 1 (IGF- 1) exert significant effects on body composition, and lipid and glucose homeostasis [ 10 ]. A wealth of studies reported that in obese subjects GH secretion is blunted [ 10 – 12 ], and GH and IGF- 1 have been proven to be involved in fatty infiltration of the liver [ 13 , 14 ]. Likewise, ectopic fat deposition seems to be linked to reduced GH levels [ 10 , 15 ], as well as impairment in GH production occurring with aging is one of the causes of the changes in body compartments leading to both excess adiposity and sarcopenia [ 16 ].…”