High prevalence of metabolic syndrome features in patients previously treated for nonfunctioning pituitary macroadenoma

Sjoerd D Joustra; Kim M J A Claessen; Olaf M Dekkers; André P van Beek; Bruce H R Wolffenbuttel; Alberto M Pereira; Nienke R Biermasz

doi:10.1371/journal.pone.0090602

High prevalence of metabolic syndrome features in patients previously treated for nonfunctioning pituitary macroadenoma

PLoS One. 2014 Mar 7;9(3):e90602. doi: 10.1371/journal.pone.0090602. eCollection 2014.

Authors

Sjoerd D Joustra¹, Kim M J A Claessen¹, Olaf M Dekkers², André P van Beek³, Bruce H R Wolffenbuttel³, Alberto M Pereira¹, Nienke R Biermasz¹

Affiliations

¹ Center for Endocrine Tumors Leiden, Department of Endocrinology and Metabolism, Leiden University Medical Center, Leiden, Netherlands.
² Center for Endocrine Tumors Leiden, Department of Endocrinology and Metabolism, Leiden University Medical Center, Leiden, Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands.
³ Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.

Abstract

Objective: Patients 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.

Design: The 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).

Results: NFMA 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).

Conclusions: Patients 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.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Aged, 80 and over
Cross-Sectional Studies
Female
Humans
Male
Metabolic Syndrome / epidemiology*
Metabolic Syndrome / physiopathology
Middle Aged
Pituitary Neoplasms / epidemiology*
Pituitary Neoplasms / physiopathology
Prevalence
Risk Factors

Grants and funding

The LifeLines Cohort Study was supported by the Netherlands Organization of Scientific Research (NWO) [grant 175.010.2007.006]; the Economic Structure Enhancing Fund (FES) of the Dutch government; the Ministry of Economic Affairs; the Ministry of Education, Culture and Science; the Ministry for Health, Welfare and Sports; the Northern Netherlands Collaboration of Provinces (SNN); the Province of Groningen; University Medical Center Groningen; the University of Groningen; the Dutch Kidney Foundation; and the Dutch Diabetes Research Foundation. A.M.P. received consultancy and lecture fees from Novartis, Ipsen, and Pfizer. N.R.B is supported by a NWO-VENI grant of the Netherlands, no 016.136.125. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.