ECE2018 Poster Presentations: Pituitary and Neuroendocrinology Pituitary - Clinical (101 abstracts)
Clinical relevance of metabolic phenotype in hypopituitarism: what really matters?
Dragana Miljic 1, , Sandra Pekic 1, , Mirjana Doknic 1, , Marko stojanovic 1, , Marina Nikolic-Djurovic 1, , Milica Medic-Stojanoska 3, , Verica Milosevic 5, , Branka Sosic-Jurijevic 7, , Vladimir Ajdzanovic 5 , Zvezdana Jemuovic 1 , Ivan Soldatovic 8, , Vera Popovic 2 & Milan Petakov 1,
1Clinic of Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Belgrade, Serbia; 2Belgrade School of Medicine, Belgrade Univresity, Belgrade, Serbia; 3Clinic of Endocrinology, Clinical Center of Novi Sad, Novi Sad, Serbia; 4Medical Faculty, University of Novi Sad, Novi Sad, Serbia; 5Department of Cytology, Institute for Biological Research ‘Sinisa Stankovic’, Belgrade, Serbia; 6Belgrade University, Belgrade, Serbia; 7Department of Cytology, Institute for Biological Research ‘Sinisa Stankovic’, Belgrade, Serbia; 8Institute of Medical Statistics and
Informatics, Belgrade, Serbia.
Previous studies reported increased prevalence of metabolic syndrome (MS) and mortality rates from cardiovascular causes in hypopituitary patients. Fatty liver disease was added recently to this unfavorable cardio-metabolic phenotype. We studied the prevalence of MS and non-alcoholic fatty liver disease (NAFLD) in unselected cohort of 282 hypopituitary patients (146 male), mean age 49.2±15.1 years, on standard replacement therapy (76.4% received l-thyroxin, 76% hydrocortisone, 9.8% gonadal steroids, 4.6% desmopressin, 1.8% growth hormone). Surrogat marker of MS, lipid acummulation product (LAP) was calculated using gender specific formulas including waist circumference and triglyceride level. Marker of NAFLD, fatty liver index (FLI) was calculated using formula including body weight, height, waist circumference, triglyceride and gamma glutamyl transferase levels. Hepatic steatosis was assessed by ultrasonography and liver function tests. In this cross-sectional study, prevalence of MS was 57.1% (using IDF) and 48.6% (with ATP III criteria). MS was more common in females than males (IDF 63.2% vs 51.4%, P=0.044; ATP III 54.4% vs 43.2%, P=0.059) and significantly associated with unreplaced hypogonadism in female patients (P=0.003). Statistically significant associations (P<0.001) were found for MS and age, obesity, adult onset of hypopituitarism and NAFLD. Prevalence of NAFLD in the cohort was 20.6%, based on ultrasonographic features of hepatic steatosis, while in addition to this 7.1% had elevated liver enzymes. For NAFLD, statistically significant associations were found with MS (P<0.001), etiology of non-functioning pituitary macroadenoma (P=0.006) and growth hormone deficiency (P=0.026). Hypopitutary patients with NAFLD had more severe features of MS with significantly higher body mass index, waist circumference, cholesterol and triglycerides, LAP and FLI, but lower HDL compared to no-NAFLD patients (P<0.001). ROC analysis confirmed that LAP and FLI were reliable markers of hepatic steatosis and functional hepatic impairment resulting from NAFLD. MS is common in hypopituitarism, featuring NAFLD in one third of hypopituitary patients with MS. Hypopituitary NAFLD patients present with more severe MS and higher LAP and FLI indexes compared to no-NAFLD patients. LAP and FLI are reliable markers of hepatic steatosis and functional hepatic impairment, resulting from NAFLD. Complex interactions of multiple pituitary hormone deficiencies and balance in their replacement are very important for metabolic phenotype, as well as age, gender, obesity, adult onset and etiology of hypopituitarism.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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