title: High prevalence of metabolic syndrome features in patients previously treated for nonfunctioning pituitary macroadenoma.
abstract: OBJECTIVE
  Patients treated for nonfunctioning pituitary macroadenoma (NFMA) with suprasellar extension show disturbed sleep characteristics, possibly related to hypothalamic dysfunction. In addition to hypopituitarism, both structural hypothalamic damage and sleep restriction per se are associated with the metabolic syndrome. However, the prevalence of the metabolic syndrome in patients with NFMA is not well established. Our objective was to study the prevalence and risk factors for (components of) the metabolic syndrome in patients treated for NFMA.
  
  
  METHODS
  The metabolic syndrome (NCEP-ATP III criteria) was studied in an unselected cohort of 145 NFMA patients (aged 26-88yr, 44% female) in long-term remission after treatment, receiving adequate stable hormone replacement for any pituitary deficiencies. The results were compared to population data of 63,995 Dutch inhabitants by standardization (LifeLines cohort study).
  
  
  RESULTS
  NFMA patients showed increased risk for reduced HDL-cholesterol (SMR 1.59, 95% CI 1.13-2.11), increased triglyceride levels (SMR 2.31, 95% CI 1.78-2.90) and the metabolic syndrome (SMR 1.60, 95% CI 1.22-2.02), but not for increased blood pressure, waist circumference or hyperglycemia. Preoperative visual field defects independently affected the risk for increased blood pressure (OR 6.5, 95% CI 1.9-22.2), and hypopituitarism was associated with a body mass index - dependent risk for increased waist circumference (OR 1.6, 95% CI 1.2-2.2) and the metabolic syndrome (OR 1.4, 95% CI 1.0-1.9).
  
  
  CONCLUSIONS
  Patients treated for NFMA are increased at risk for developing the metabolic syndrome, mainly due to decreased HDL-cholesterol and increased triglycerides. Risk factors included hypopituitarism and preoperative visual field defects. Hypothalamic dysfunction may explain the metabolic abnormalities, in addition to intrinsic imperfections of hormone replacement therapy. Additional research is required to explore the relation between derangements in circadian rhythmicity and metabolic syndrome in these patients.
authors.affiliation: Center for Endocrine Tumors Leiden, Department of Endocrinology and Metabolism, Leiden University Medical Center, Leiden, Netherlands.
authors.forename: Sjoerd D
authors.initials: SD
authors.lastname: Joustra
authors.affiliation: Center for Endocrine Tumors Leiden, Department of Endocrinology and Metabolism, Leiden University Medical Center, Leiden, Netherlands.
authors.forename: Kim M J A
authors.initials: KM
authors.lastname: Claessen
authors.affiliation: Center for Endocrine Tumors Leiden, Department of Endocrinology and Metabolism, Leiden University Medical Center, Leiden, Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands.
authors.forename: Olaf M
authors.initials: OM
authors.lastname: Dekkers
authors.affiliation: Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
authors.forename: André P
authors.initials: AP
authors.lastname: van Beek
authors.affiliation: Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
authors.forename: Bruce H R
authors.initials: BH
authors.lastname: Wolffenbuttel
authors.affiliation: Center for Endocrine Tumors Leiden, Department of Endocrinology and Metabolism, Leiden University Medical Center, Leiden, Netherlands.
authors.forename: Alberto M
authors.initials: AM
authors.lastname: Pereira
authors.affiliation: Center for Endocrine Tumors Leiden, Department of Endocrinology and Metabolism, Leiden University Medical Center, Leiden, Netherlands.
authors.forename: Nienke R
authors.initials: NR
authors.lastname: Biermasz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology* / Q000503:physiopathology; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000453:epidemiology* / Q000503:physiopathology; D015995:Prevalence; D012307:Risk Factors