| Objective: 1.To establish a database about adult patients with hypopituitarism（HP）,which included the general conditions,the functions of pituitary gland and the target gland axis and causes of patients.2.To analyze the correlation between hormonal deficiency of pituitary gland and its target gland axis and abnormal glucose and lipid metabolism.3.To discuss the effect of hormone replacement therapy on glucose and lipid metabolism in patients with hypopituitarism.It is hoped that this can provide a basis for early detection and intervention of glucose and lipid metabolic disorders in patients with hypopituitarism in clinical practice.Method: According to the inclusion and exclusion criteria,patients who were hospitalized in the First Hospital of Jilin University from July 2018 to October 2021 and clearly diagnosed with HP were selected as the study population.We checked the medical record management system to obtain the clinical data of the patients,including general data,medical history,physical examination data and auxiliary examination data.The patients’ general condition,pituitary function,hormone replacement therapy,glucose and lipid metabolism characteristics and the effect of hormone replacement therapy on glucose and lipid metabolism retrospectively analyzed.All data were statistically analyzed by SPSS 25.0 software.Results: 1.General data: A total of 324 patients were included in the study,including 164 males and 160 females,with a median age of 54（42-64）years.There were no significant differences in age and blood pressure between men and women,no significant difference in the prevalence of diabetes mellitus,hypertension,and coronary heart disease and a significantly higher history of smoking and drinking in men than in women（P < 0.001）.2.Etiology: The etiology of patients included surgery in the sella region（123 cases,38.0%）,tumor in the sella region（66 cases,21.3%）,postpartum hemorrhage（16 cases,4.9%）,and immunotherapy for malignancy（12 cases,3.7%）,hypophysitis（11 cases,3.4%）,vacuolar sella（11 cases,3.4%）,other [head radiotherapy,trauma,pituitary stroke,structural abnormalities of sella region（pituitary imaging suggesting abnormal signal in sella region,poorly pituitary display,small pituitary volume,pituitary nodules or suspicious nodule shadow,etc.）in 50 cases（15.4%）],and 35 cases of unknown etiology（10.8%）.3.Functional assessment of pituitary and target gland axis: The assessment rates of growth hormone axis,gonadal axis,thyroid axis and adrenal cortex axis were respectively 22.8%,72.2%,100.0%,100.0%.The proportion of hypofunction was respectively 58.1%,74.8%,70.7%,80.9%.The patients with central diabetes insipidus caused by posterior pituitary involvement accounted for 24.7%.4.Hormone replacement therapy: In the 136 patients who were non-first diagnosis,the hormone replacement rates of each hormone axis were from in descending order: posterior pituitary gland（78.1%）,thyroid axis（71.3%）,adrenal cortex axis（67.7%）,gonadal axis（41.7% for male,33.3% for female）and growth hormone axis（15.4%）.5.Glucose and lipid metabolism and other clinical indicators: The overweight and obesity rate of 324 patients with HP was 42.3%.The prevalence of diabetes mellitus was 22.5%,higher than that of general population（11.2%）,and the incidences of hypoglycemia and hyperglycemia were 11.4% and 43.8%,respectively.The rate of dyslipidemia is 71.8%,which was higher than that of the general population in China（40.4%）.The prevalence rate of non-alcoholic fatty liver disease was 51.9%,and that of liver cirrhosis was 1.6%,totaling 53.4%,higher than that of general population（29.2%）.In liver function tests,aspartate aminotransferase（AST）,γ-glutamyl aminotransferase（γ-GT）and total bile acids（TBA）were increased significantly（27.9%,17.1% and 17.2%）.The prevalence of hyperuricemia（HUA）was 22.6%.The rate of hemoglobin（Hb）lower than normal was 41.6%,and the prevalence of hyponatremia was 39.8%.6.Effects of impaired pituitary function on glucose and lipid metabolism: Patients were grouped according to the involvement of each pituitary-target gland axis and hormone replacement therapy,and were divided into hormone sufficiency group and hormone deficiency group（non-replacement group,replacement reaching standard group and replacement not reaching standard group）.The results showed that LDL-C levels in the thyroid hormone（TH）replacement not reaching standard group were higher than those in the other three groups（P=0.005）,HDL-C levels in the glucocorticoid（GC）non-replacement group were lower than those in the other three groups（P<0.001）,uric acid levels in the antidiuretic hormone（ADH）replacement group were significantly higher than those in the hormone sufficiency group（P=0.003）,and the level of body mass index（BMI）in the ADH replacement group were significantly higher than those of the other two groups（P=0.006）,and analysis of the gonadal axis showed that there were no significant differences between groups.7.Changes of glucose and lipid metabolism before and after hormone replacement therapy: Patients who were diagnosed with HP for the first time in this center and for whom follow-up data available were selected,and there was no significant difference in the glucose and lipid metabolism before and after hormone replacement therapy（P>0.05）.8.The effect of whether hormone replacement therapy reached standard on glucose and lipid metabolism: Patients with simultaneous thyroid axis,adrenal axis and gonadal axis involvement and hormone replacement therapy not reaching standard were selected for follow-up.Patients were divided into two groups（hormone replacement reaching standard group and not reaching standard group）according to whether hormone replacement reached the standards at the time of follow-up,and the glucose and lipid metabolism were compared between the two groups.There was no statistical difference between the two groups at baseline,and the HDL-C level in the hormone replacement reaching standard group was significantly higher than that in the not reaching standard group at the follow-up visit（P=0.044）.Conclusions: 1.The incidence of diabetes mellitus,dyslipidemia,metabolic-associated fatty liver disease,and hyperuricemia in patients with hypopituitarism is higher than that in the general population in China,and hypopituitarism can lead to abnormal glucose and lipid metabolism.2.Short-term glucocorticoid,thyroid hormone,sex hormone,and vasopressin replacement therapy without growth hormone failed to significantly improve glucolipid metabolic abnormalities in patients with HP. |
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