Endocrine Abstracts

Aim: Sleep disturbances are widespread and closely associated with pituitary diseases, even those under long-term therapeutic management. The aim of this study was to investigate sleep quality, depression, anxiety, and physical activity in patients with non-functioning pituitary adenoma (NFPA) and determine the factors that might be associated with decreased quality of sleep.

Method: Eighty-two patients with NFPAs and 82 age- and gender-matched control subjects were included. Information on the patients’ clinical findings, laboratories and imagings, therapies for pituitary insufficiency were documented. Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale (HADS) and International Physical Activity Questionnaire (IPAQ-SF) were used to evaluate sleep quality, depression, anxiety, and physical activity of participants.

Results: Eighty-six percent of the patients with NFPAs had macroadenoma and mean largest diameter was 22.0 mm. Intact pituitary function was present in 47.6% of patients with NFPAs. In the NFPA group, 57.3% of patients had decreased sleep quality, while 35.4% of patients in the control group (P=0.005). Anxiety and depression scores were higher and physical activity scores were lower in NFPAs than in the control group (P<0.05). Although there was no relationship between the presence of hydrocortisone replacement or total daily dosage and sleep quality in patients with secondary adrenal insufficiency (P>0.05), there was a strong positive correlation between PSQI and morning hydrocortisone replacement time (r=0.834, P<0.001). The presence of both transcranial surgery and diabetes insipidus was also found to be significantly higher in the group with decreased sleep quality (P<0.05). There was a negative correlation between PSQI and IGF-1 and free T4 levels in patients with NFPAs (r=-0.259, P=0.01) (r=-0.392, P<0.01). A multivariate logistic regression model revealed that depression score and free T4 level in the upper half of the normal limit were the most associated factors for sleep quality.

Conclusions: Our study indicated that patients with NFPAs had decreased sleep quality compared to age- and gender- matched controls. Presence of depression and a free T4 level in the upper half of the normal range were the most associated factors, along with presence of transcranial surgery, low IGF-1 levels, diabetes insipidus, and morning hydrocortisone replacement time.