Endocrine Abstracts

Introduction: Recent studies showed that morphometric vertebral fractures (VF) are an early and frequent complication in patients (pts) withhyperfunctioning pituitary adenomas and hypopituitarism (independently from the etiology). GH excess or severe deficiency play a negative key role on bone health in this clinical setting. Disease control or adequate replacement therapies still remain a cornerstone for the clinician to reduce the burden of osteo-metabolic complications. To date, however, data on skeletal outcomes in pts with non-functioning pituitary adenomas (NFPA) are scanty.

Purpose of the study: To retrospectively evaluate the prevalence and determinants of VF in pts with NFPA.

Patients and Methods: We consecutively enrolled 98 pts [51 males (M), 47 females (F); mean age 53 ± 12 years old] with NFPA, attending the Pituitary Unit in IRCCS Ospedale San Raffaele for trans-sphenoidal surgery (TNS). We collected all biochemical data on pituitary function and histological exams. Pituitary hormonal deficiency was defined in case of low peripheral hormone levels and inappropriately normal or low pituitary hormones or in all those cases when replacement therapy was already prescribed. Consequently, hypopituitarism was defined by the presence of at least one pituitary deficiency. The vertebral fracture assessment (VFA) was based on Genant classification and completed on chest X-ray (MTRx), performed for anesthesiologic reasons.

Results: We observed a high prevalence of VF in pts with NFPA: 27 out of 98 pts (27.5%) were fractured and 10 (37.04%) had multiple VF, with no gender differences (M17/F10; P = 0.18). Fractured pts were significantly older than non-fractured ones (mean age 57.93 ± 12.52 vs 51.83 ± 11.94; P = 0.03). Moreover, pts with VF had significantly lower levels of fT3 (mean 2.26 ± 0.71 vs 2.71 ± 0.55 pg/ml; P = 0.005) and GH (mean 0.39 ± 0.53 vs 0.85 ± 1.72 mg/ml; P = 0.05). Based on biochemical parameters of pituitary axes, 56 pts (57.14%) had hypopituitarism. The prevalence of VF was significantly higher in pts with hypopituitarism: 20 out of 56 pts showed VF (35.7%) as compared to those without hypopituitarism (7/42, 16.67%) (P = 0.04). Finally, the histological examination was positive for FSH in a significantly higher number of pts with VF than in non-fractured ones (15/27, 55.56% vs 23/71, 32.39%; P = 0.04).

Conclusions: Our data demonstrated a high prevalence of VF in pts with NFPA. Based on these results, we suggest to perform a VFA in pts with NFPA at diagnosis, particularly those with hypopituitarism. Prospective post-surgical studies are needed to evaluate the incidence of VF and its relationship to biochemical and histological parametrs as well as surgical outcomes.