Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 14, 2019; 25(14): 1741-1752
Published online Apr 14, 2019. doi: 10.3748/wjg.v25.i14.1741
Clinical characteristics of non-alcoholic fatty liver disease in Chinese adult hypopituitary patients
Xian-Xian Yuan, Hui-Juan Zhu, Hui Pan, Shi Chen, Ze-Yu Liu, Yue Li, Lin-Jie Wang, Lin Lu, Hong-Bo Yang, Feng-Ying Gong
Xian-Xian Yuan, Hui-Juan Zhu, Hui Pan, Shi Chen, Lin-Jie Wang, Lin Lu, Hong-Bo Yang, Feng-Ying Gong, Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission of the People's Republic of China, The Translational Medicine Center of Peking Union Medical College Hospital, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
Ze-Yu Liu, Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
Yue Li, Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
Author contributions: All authors helped to perform the research; Zhu HJ conceived and designed the project; Pan H, Gong FY, and Zhu HJ contributed to the project management; Chen S, Wang LJ, Lu L, and Yang HB took part in the collection of clinical samples; Yuan XX and Liu ZY took part in the statistical analysis; Yuan XX and Zhu HJ wrote the manuscrip; and Li Y took part in the revision of the manuscript.
Supported by the National Key Program of Clinical Science, No. WBYZ 2011-873; the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences, No. 2016YFC0901500; and the Special Research Fund for Central Universities, Peking Union Medical College, No. 2017PT31004.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Peking Union Medical College Hospital (No. JS1233).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained from the Electronic Medical Record of Peking Union Medical College Hospital.
Conflict-of-interest statement: There is no conflict of interest regarding the work presented in this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Hui-Juan Zhu, MD, Professor, Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission of the People's Republic of China, The Translational Medicine Center of Peking Union Medical College Hospital, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1, Shuaifuyuan, Dongcheng District, Beijing 100730, China. shengxin2004@163.com
Telephone: +86-10-69155073 Fax: +86-10-69155073
Received: January 13, 2019
Peer-review started: January 14, 2019
First decision: February 13, 2019
Revised: March 13, 2019
Accepted: March 15, 2019
Article in press: March 16, 2019
Published online: April 14, 2019
Abstract
BACKGROUND

Patients with hypothalamic-pituitary disease have the feature of central obesity, insulin resistance, and dyslipidemia, and there is increased prevalence of liver dysfunction consistent with non-alcoholic fatty liver disease (NAFLD) in this population. The causes of hypopituitarism in the reported studies varied and combined pituitary hormone deficiency including central diabetes insipidus is much common in this population. This retrospective cross-sectional study was performed to analyze the clinical characteristics and related factors with NAFLD and cirrhosis in Chinese adult hypopituitary/panhypopituitary patients.

AIM

To analyze the clinical characteristics of and related risk factors for NAFLD in Chinese adult hypopituitary patients.

METHODS

Adult Chinese patients with hypopituitarism and/or panhypopituitarism were enrolled at the Pituitary Center of Peking Union Medical College Hospital between August 2012 and April 2018. According to abdominal ultrasonography, these patients were divided into an NAFLD (-) group and an NAFLD (+) group, and the latter was further divided into an NAFLD group and a cirrhotic group. The data, such as patient characteristics, diagnosis, and treatment, were extracted from medical records, and statistical analysis was performed.

RESULTS

A total of 36 male and 14 female adult Chinese patients with hypopituitarism were included in this retrospective study; 43 (87.0%) of these patients exhibited growth hormone (GH) deficiency, and 39 (78.3%) had diabetes insipidus. A total of 27 (54.0%) patients were diagnosed with NAFLD, while seven patients were cirrhotic. No significant differences were noted in serum GH or insulin-like growth factor 1 among patients with cirrhosis, subjects with NAFLD, and those without NAFLD. However, plasma osmolality and serum sodium concentration of the cirrhotic patients were 314.9 mOsm/kgH2O and 151.0 mmol/L, respectively, which were significantly higher than those of the NAFLD patients (P = 0.036 and 0.042, respectively). Overweight/obesity and insulin resistance were common metabolic disorders in this population. The body mass index (BMI) and homeostasis model assessment of insulin resistance parameters of the cirrhotic patients were 27.7 kg/m2 and 9.57, respectively, which were significantly higher than those of the patients without NAFLD (P = 0.011 and 0.044, respectively). A correlation analysis was performed, and fasting insulin concentration was positively associated with plasma osmolality in patients with NAFLD, after adjusting for gender, age, and BMI (r = 0.540, P = 0.046), but no correlation was noted in patients without NAFLD.

CONCLUSION

NAFLD is common in patients with hypopituitarism. Plasma osmolality and serum sodium levels of hypopituitary patients with cirrhosis are higher than those of subjects with NAFLD, and fasting insulin concentration is positively associated with plasma osmolality in patients with NAFLD, which suggests that hyperosmolality might be a contributor to the worsening of NAFLD in hypopituitary patients.

Keywords: Hypopituitarism, Non-alcoholic fatty liver disease, Cirrhosis, Diabetes insipidus, Plasma osmolality

Core tip: Fifty-four percent of hypopituitary patients in this retrospective study were diagnosed with non-alcoholic fatty liver disease (NAFLD), which was significantly higher than that of the general adult population in China. Growth hormone (GH) deficiency has been considered an important contributing factor to NAFLD in those patients. However, no significant differences were noted in GH or insulin-like growth factor 1 among patients with cirrhosis, subjects with NAFLD, and those without NAFLD in this study. Interestingly, we found that plasma osmolality and serum sodium concentration of the cirrhotic patients were significantly higher than those of the NAFLD patients. In addition, fasting insulin concentration was positively associated with plasma osmolality in patients with NAFLD. Additional studies are required to confirm that hyperosmolality may be a significant contributor to the worsening of NAFLD in hypopituitary patients.