Session: MON 88-111-Cushing's Disease & Non-Functioning Hypothalamus-Pituitary Tumors
Poster Board MON-106
1,2 Giavoli C., 1,2 Profka E., 1,2 Bergamaschi S., 1,2 Ferrante E., 1,2 Malchiodi E., 1,2 Sala E., 1,2 Verrua E., 1,2 Spada A, 1,2 Beck-Peccoz P.
1Departement of Medical Sciences and Community Health, University of Milan, 2Endocrinology and Diabetology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
Patients with craniopharyngioma (CP) are more often operated by transcranial route than patients with non-functioning pituitary adenoma (NFPA), have higher prevalence of pituitary deficiencies, are more obese and dyslipidemic and have a higher mortality rate. A recent study reported that in CP patients tumour recurrence or enlargement is not related to rhGH. Conversely, metabolic effects of rhGH therapy in these subjects have been so far less investigated, though a previous report showed that effects of 2-yrs rhGH replacement are similar in patients operated for CP and in patients operated for NFPA, except for less reduction in body fat (BF%) in CP patients. Aim of the study was to compare both short- (12 months) and long-term (5 years) effects of rhGH (mean dose after titration 0.34±0.18 mg/day) in 36 GHD adult patients, 18 operated for CP (11M-7F, mean age 41±12 yrs) and 18 for NFPA (12M-6F, mean age 45±12 yrs). Serum IGF-I, lipid profile, glucose metabolism and BF% were evaluated. At baseline no difference between the two groups was observed, apart from a higher prevalence of diabetes insipidus in CP patients than in those with NFPA (83% vs 22%, respectively). After 12 months, IGF-I SDS normalized and BF% significantly decreased in both groups. During long-term treatment, increase in IGF-I levels was maintained, while decrease in BF% was persistent only in NFPA group (from 32±10.6 to 30±10%, P<0.05 in NFPA and form 33.4±8% to 31.7±7%, P=NS, in CP). Only in CP patients a long-term worsening of insulin sensitivity, documented by increase in insulin levels and HbA1c (from 10.1±6.2 to 13.5±9.4 uIU/ml and from 5.0±0.6 to 5.9±0.99%, respectively, P<0.05) and decrease of QUICKI (from 0.36±0.04 to 0.33±0.03, P<0.05) was observed. On the contrary, a significant improvement in lipid profile shown by reduction in total cholesterol during short-term (from 225±61 to 209±52 mg/dl, P<0.05) and reduction of LDL-cholesterol during long-term (from 148±44 to 122±41 mg/dl, P<0.05) was present only in NFPA group. In conclusion, the present data suggest that patients with CP are less sensitive to the positive rhGH effects on lipid profile than patients with NFPA. Moreover, we confirm that BF% reduction in CP is less than in NFPA patients also during long-term treatment, a condition that might explain the long-term worsening of insulin sensitivity observed only in the former group.
Nothing to Disclose: CG, EP, SB, EF, EM, ES, EV, AS, PB
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