ECE2022 Eposter Presentations Pituitary and Neuroendocrinology (211 abstracts)
MRI intensity and pituitary volume predict adult-onset growth hormone deficiency in patients with obesity and overweight: a new potential tool guiding subsequent diagnostic testing
Davide Masi 1 , Renata Risi 1 , Angela Balena 1 , Alessandra Caputi 1 , Maria Elena Spoltore 1 , Rebecca Rossetti 1 , Mikiko Watanabe 1 , Rossella Tozzi 2 , Elena Gangitano 1 , Mariaignazia Curreli 1 , Stefania Mariani 1 , Andrea Lenzi 1 , Lucio Gnessi 1 & Carla Lubrano 1
1Sapienza University of Rome, Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Roma, Italy; 2Sapienza University of Rome, Department of Molecular Medicine, Roma, Italy
Background: Reduced growth hormone (GH) secretory capacity is common in patients with obesity and metabolic derangements. The prevalence of GH deficiency (GHD) in this population is difficult to establish. Magnetic Resonance Imaging (MRI) pituitary findings may reflect specific endocrine alterations, as for GHD which is associated with lower pituitary height and volume (PV).
Purpose: Our aim was to identify the pituitary morphological alterations predicting GHD in subjects with obesity or overweight.
Methods: We conducted a retrospective evaluation of 152 patients undergoing pituitary-MRI and a dynamic test (GHRH+arginine) for suspected adult-onset GHD admitted to our institution from 2015 to 2022. Clinical history and anthropometric parameters were collected. Mean and standard deviation (SD) of pituitary signal intensity was quantified (Horos, Nimble Co, Annapolis, MD USA). Gray matter signal intensity was used as a normalizer. PV was calculated by adopting the ellipsoid formula.
Results: Of 152 patients, 126 had obesity (BMI: 39±6 Kg/m2) and 26 were overweight (BMI: 28 ±1 Kg/m2). An inverse correlation between BMI and PV was observed (r = -.2844, P<0.0001). Of note, after normalization with grey matter intensity, T2-weighted-scan derived pituitary intensity and PV showed an inverse correlation (r = -.2761, P=0.008). As far as GH secretory capacity is concerned, we found a direct correlation between the area under the curve of the dynamic test and pituitary volume (PV) (r = .41488, P<0.0001). Finally, a receiver operating characteristic curve allowed to identify a PV < 75.8 ml and a pituitary height < 3.7 mm as predictors of GHD with a sensitivity of 86.1% and 72.2% and a specificity of 63.6% and 64.5%, respectively.
Conclusion: Our work demonstrates that patients with obesity exhibit a GH-IGF1 axis impairment associated with a reduced PV. Furthermore, we found an inverse correlation between PV, pituitary intensity and GH secretion capacity. The increase in pituitary intensity may reflect the presence of an inflammatory infiltrate possibly leading to pituitary damage and subsequent shrinkage, although this hypothesis needs to be confirmed with ad hoc studies. When subjects suffering from overweight/obesity undergo a head MRI for other reasons, those not reaching the identified cut off values of PV and pituitary coronal height predicting GHD in our cohort, might benefit from undergoing dynamic testing in order to assess for eventual GHD.
Key Words: obesity, pituitary volume, Growth Hormone Deficiency
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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