title: Prevalence of GH and other anterior pituitary hormone deficiencies in adults with nonsecreting pituitary microadenomas and normal serum IGF-1 levels.
abstract: OBJECTIVE
  GH is usually the first pituitary hormone to be affected following a pathological insult to the pituitary; however, data on the prevalence of GH deficiency in patients with nonsecreting pituitary microadenomas and normal serum IGF-1 levels are scarce. This study aims to evaluate the prevalence of GH and other anterior pituitary hormone deficiencies, and to determine whether microadenomas per se could be associated with reduced GH response rates to GHRH-arginine stimulation.
  
  
  METHODS
  Analytical, retrospective, two-site case-control study.
  
  
  METHODS
  Thirty-eight patients with nonsecreting pituitary microadenomas (mean size 4.2 mm) and normal serum IGF-1 levels were studied. Anterior pituitary function testing, including the GHRH-arginine test to examine GH reserve, was performed in all patients. Serum IGF-1 levels and peak GH levels in the patients that passed the GHRH-arginine test were compared with 22 age- and BMI-matched healthy controls.
  
  
  RESULTS
  Nineteen patients (50%) failed the GHRH-arginine test and had higher body mass index (BMI) than those that passed the GHRH-arginine test and healthy controls. Peak GH levels in patients that passed the GHRH-arginine test were lower compared to healthy controls and 19 patients (50%) had at least one other pituitary hormone deficit. A negative correlation (r = -0.42, P < 0.01) between peak GH levels and BMI was identified, but no correlations were found between peak GH and serum IGF-1 levels.
  
  
  CONCLUSIONS
  Our data demonstrated that a substantial number of patients with nonsecreting pituitary microadenomas failed the GHRH-arginine test despite normal serum IGF-1 levels, and had at least one other pituitary hormone deficiency, suggesting that nonsecreting microadenomas may not be clinically harmless. We therefore recommend long-term follow-up with periodic basal pituitary function testing, and to consider dynamic pituitary testing should clinical symptoms arise in these patients.
authors.affiliation: Department of Endocrinology, Oregon Health and Science University, Portland, OR 97239-3098, USA. yuenk@ohsu.edu
authors.forename: Kevin C J
authors.initials: KC
authors.lastname: Yuen
authors.forename: David M
authors.initials: DM
authors.lastname: Cook
authors.forename: Prem
authors.initials: P
authors.lastname: Sahasranam
authors.forename: Pragnesh
authors.initials: P
authors.lastname: Patel
authors.forename: David E
authors.initials: DE
authors.lastname: Ghods
authors.forename: Hrayr K
authors.initials: HK
authors.lastname: Shahinian
authors.forename: Theodore C
authors.initials: TC
authors.lastname: Friedman
mesh_terms: D000236:Adenoma / Q000097:blood / Q000150:complications / Q000453:epidemiology* / Q000378:metabolism; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D019382:Human Growth Hormone / Q000172:deficiency*; D006801:Humans; D007018:Hypopituitarism / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D007334:Insulin-Like Growth Factor I / Q000032:analysis / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D010908:Pituitary Hormones, Anterior / Q000172:deficiency*; D010911:Pituitary Neoplasms / Q000097:blood / Q000150:complications / Q000453:epidemiology* / Q000378:metabolism; D015995:Prevalence; D012189:Retrospective Studies
chemical_list: D010908:Pituitary Hormones, Anterior; D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I