Endocrine Abstracts (2011) 26 P270

Primary empty sella is associated with increased cardiovascular risk, regardless the occurrence of pituitary dysfunction

M L Torre1, O R Cotta1, F Ferraù1, E Di Mauro1, A Albani1, M Boschetti2, C Teti2, M C Savanelli3, C Di Somma3, A Alibrandi1, D Ferone2, S Cannavò1 & A Colao3

1Section of Endocrinology, Department of Medicine and Pharmacology, University of Messina, Messina, Italy; 2Unit of Endocrinology DiSEM, University of Genoa, Genoa, Italy; 3Department of Endocrinology and Molecular Oncology, University ‘Federico II’ of Naples, Naples, Italy.

Introduction: Primary empty sella (PES) is a frequent ‘incidental’ finding reported in 5–25% of general population and is associated with endocrine abnormalities in 8–60% of cases. In this collaborative multicentric study we evaluated cardiovascular risk by assessing clinical characteristics, glucidic profile and lipid parameters.

Design: A total of 94 PES patients (39M-55F; mean age 50.3±0.9 years; mean BMI 28.9±0.5 kg/m2) and 126 normal subjects (C) matched for sex, age and BMI were studied. Hypothalamic–pituitary function was evaluated at baseline and following conventional dynamic tests (GHRH plus arginine, ACTH test) in all patients. Cardiovascular risk parameters were assessed in all subjects. Statistical analysis was carried out by non parametric combination test and partial correlation test.

Results: Sixty-four patients (68%) had a single or multiple pituitary hormone deficiency: growth hormone deficiency was diagnosed in 56 (87.5%), central hypothyroidism in 35 (54.6%), hypogonadotropic hypogonadism in 32 (50%) and central hypoadrenalism in 24 (37.5%).

Mean systolic blood pressure (SBP), HOMA index, total and LDL cholesterol, triglycerides, LDL/HDL and total/HDL cholesterol ratios were significantly higher and HDL cholesterol levels were significantly lower in patients, regardless the occurrence of endocrine dysfunction, than in C group (P<0.02). These cardiovascular risk parameters were not significantly different between patients with or without hypopituitarism. Partial correlation test showed that occurrence of central hypothyroidism was associated with high total and LDL cholesterol levels, LDL/HDL, total/HDL cholesterol ratios and HOMA index (P<0.02), whereas hypogonadotropic hypogonadism was associated to low HDL cholesterol, high LDL/HDL and total/HDL cholesterol ratios (P<0.02). On the contrary, central hypoadrenalism was associated to low systolic and diastolic blood pressure (P<0.02).

Conclusions: Patients with empty sella show increased cardiovascular risk parameters regardless of endocrine dysfunction. In particular, occurrence of central hypothyroidism and/or hypogonadotropic hypogonadism was associated with glucidic and lipid abnormalities.