Endocrine Abstracts

Introduction: Insulin resistance (IR) is prevalent in patients with hypopituitarism receiving conventional replacement therapy. Recognizing and addressing IR in women with hypopituitarism is crucial for comprehensive patient management and prevention of other metabolic complications. The aims of this study were to determine the prevalence of IR and to assess its associated factors in women with hypopituitarism.

Methods: This was a monocentric cross-sectional study including 50 patients with complete anterior hypopituitarism secondary to Sheehan’s syndrome (SS) and 50 age, and body-mass index (BMI)-matched women controls. Participants underwent physical examination and laboratory tests including fasting blood glucose and baseline insulin. Homeostatic Model Assessment of IR (HOMA-IR) index was calculated using the following formula: [Fasting Blood Glucose (mmol/l) × Basal Insulin (mIU/l)] / 22.5. IR was defined by an HOMA-IR index ≥ 2.4.

Results: The mean age was 62.2 ± 9.4 years in women with SS and 60.6 ± 8.4 years in controls (P=0.385). The mean BMI was 29.6 ± 6.0 kg/m² in patients and 30.0 ± 5.0 kg/m² in controls (P=0.741). The baseline insulin level was significantly higher in women with SS than in controls (respectively: 15.0 ± 11.6 μIU/ml vs 10.6 ± 5.5 μIU/ml, P=0.030). The HOMA-IR index was significantly higher in patients than in controls (respectively: 3.4 ± 3 vs 2.4 ± 1.2, P=0.017). The prevalence of IR was 38% in patients and 56% in controls (P=0.070). In patients with SS, factors associated with IR included age ≤ 62 years (OR=4.43, IC95%: 1.26-15.48, P=0.016), family history of obesity (OR=3.78, IC95%: 1.01-14.17, P=0.042), BMI ≥30 kg/m² (OR=1.21, IC95%: 1.06-1.40, P=0.004), body-fat ratio ≥ 30% (OR=1.13, IC95%: 1.02-1.26, P=0.021), and waist circumference ≥94 cm (OR=1.86, IC95%: 1.40-2.47, P=0.009). However, the risk of IR was not associated with the diagnostic delay of SS, disease duration, GH levels, FT4 levels, levothyroxine dose, daily or cumulative dose of hydrocortisone, and oestrogen-progesterone therapy.

Conclusions: Women with hypopituitarism had a significantly higher insulin levels and HOMA-IR ratio than controls. However, the prevalence of insulin resistant was comparable in the two groups. Age, family history of obesity, BMI, body fat ratio, and waist circumference were positively associated with IR.