Published online Apr 14, 2019. doi: 10.3748/wjg.v25.i14.1741
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
Non-alcoholic fatty liver disease (NAFLD) is a major global health problem with a substantial rise in prevalence over the last decades. Patients with hypothalamic-pituitary disease have the features of central obesity, insulin resistance, and dyslipidemia, and there is an increased prevalence of liver dysfunction consistent with NAFLD in this population. Growth hormone deficiency (GHD) has been considered as an important contributing factor to these metabolic changes in hypopituitary patients. However, the causes of hypopituitarism in the reported studies varied, and combined pituitary hormone deficiency, including central diabetes insipidus, was more common in this population. This retrospective cross-sectional study was performed to analyze clinical characteristics of NAFLD in Chinese adult hypopituitary/panhypopituitary patients, and to explore the risk factors that lead to rapid progression to cirrhosis.
The research motivation of the present study was to identify possible risk factors related to NAFLD in patients with hypopituitarism by summarizing the characteristics of NAFLD in this patient population, in order to prevent and delay the occurrence and progression of NAFLD in patients with hypopituitarism in future.
The main objectives of the present study were to analyze clinical characteristics of NAFLD in Chinese adult hypopituitary/panhypopituitary patients, and to explore the risk factors that lead to rapid progression to cirrhosis. Additional studies are required to research the mechanism of rapid progression of NAFLD to cirrhosis in hypopituitary patients.
The present study is a retrospective cross-sectional observational study. A total of 50 adult Chinese patients with hypopituitarism and/or panhypopituitarism were enrolled. The data were extracted from the medical records, including patients’ characteristics, diagnosis and treatment, biochemical and hormonal tests, and abdominal ultrasound. And then statistical analysis was performed.
Fifty-four percent of hypopituitary patients in this study were diagnosed with NAFLD, and seven patients were cirrhotic, which was significantly higher than that of the general population. Body mass index (BMI) and homeostasis model assessment of insulin resistance (HOMA-IR) of the cirrhotic patients were significantly higher than those of the patients without NAFLD. Moreover, plasma osmolality and serum sodium concentration of the cirrhotic patients were significantly higher than those of the NAFLD patients, and fasting insulin concentration was positively associated with plasma osmolality in patients with NAFLD, following adjustment for gender, age, and BMI.
The present study demonstrated a high prevalence of NAFLD and cirrhosis in patients with hypopituitarism. Hypopituitary patients with cirrhosis exhibited significantly higher BMI and HOMA-IR compared with those without NAFLD. In addition, fasting insulin concentration was positively associated with plasma osmolality in patients with NAFLD, following adjustment for gender, age, and BMI. Moreover, we report for the first time that plasma osmolality and serum sodium levels of hypopituitary patients with cirrhosis were significantly higher than those of hypopituitary patients with NAFLD. Additional studies are required to confirm that hyperosmolality may be a significant contributor to the rapid progression of NAFLD in hypopituitary patients.
There is a high prevalence of NAFLD and cirrhosis in patients with hypopituitarism, but the factors that lead to rapid progression to cirrhosis are not clear. Further studies are needed to determine whether hyperosmolality contributes to the deterioration of NAFLD in hypopituitary patients.