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Impairment of GH secretion in adults with primary empty sella

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Abstract

Primary empty sella (PES) is generally not associated with overt endocrine abnormalities, although mild hyperprolactinemia and, in children, deficient GH secretion have been reported. The aim of this multi-center collaborative study was to evaluate basal and stimulated GH secretion in a large series of adult PES patients. The study group consisted of 51 patients [41 women and 10 men, age range: 20–78 yr; (mean±SD) 47±11 yr]; results were compared with those in normal subjects (Ns) (Ns: no.=110, 55 women, age: 20–50 yr, 37±14 yr), and in hypopituitaric patients (HYP) with GH deficiency (HYP: no.=44, 17 women, age: 20–72, 49±16 yr). Baseline IGF-I levels and GH responses to insulin-induced hypoglycemia (insulin tolerance test, ITT) and/or GHRH+arginine (ARG) stimulation tests were evaluated. PES patients were also subdivided according to BMI in lean (BMI <28 kg/m2 no.=22) or obese (BMI >28 kg/m2 no.=29). PES patients had serum total IGF-I concentrations (mean±SE: 142.2±9.6 ng/ml) higher than HYP patients (77.4±6.4 ng/ml, p<0.001), but lower than Ns (213.3±17.2 ng/ml, p<0.005), with no differences between lean and obese PES subjects. The increase in serum GH concentrations following ITT and/or GHRH+ARG stimulation tests, although higher than that observed in HYP patients, was markedly reduced with respect to Ns. No difference was observed in the GH response to provocative tests between lean and obese PES patients. When individual GH responses to ITT or GHRH+ARG were taken into account, a large proportion of PES patients (52% after ITT, 61% after GHRH+ARG) showed a GH peak increase below the 1st centile of normal limits. Serum IGF-I levels in PES patients with blunted GH responses to provocative tests were significantly (p<0.001) lower in PES patients with normal GH responses, and a positive correlation was observed between IGF-I levels and serum GH peak concentrations after GHRH+ARG. In conclusion, the results of the present study provide evidence that adult PES patients often have an impairment of GH secretion, as indicated by the blunted GH response to ITT and GHRH+ARG provocative tests, and by the reduction in serum IGF-I levels. These changes are independent of body mass.

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References

  1. Bergland R.M., Ray B.S., Torack R.M. Anatomical variations in the pituitary gland and adjacent structures in 225 human autopsy cases. J. Neurosurg. 1968, 28: 93–99.

    Article  CAS  PubMed  Google Scholar 

  2. Kaufman B. The “empty” sella turcica: a manifestation of the intrasellar subarachnoid space. Radiology 1968, 90: 931–941.

    CAS  PubMed  Google Scholar 

  3. Lambert M., Gaillard R.C., Vallotton M.B., Megret M., Delavelle J. Empty sella syndrome associated with diabetes insipidus: case report and review of the literature. J. Endocrinol. Invest. 1989, 12: 433–437.

    CAS  PubMed  Google Scholar 

  4. Gallardo E., Schacter D., Caceres E., et al. The empty sella: results of treatment in 76 successive cases and high frequency of endocrine and neurological disturbances. Clin. Endocrinol. (Oxf.) 1992, 37: 529–533.

    Article  CAS  Google Scholar 

  5. Brismar K., Efendic S. Pituitary function in the empty sella syndrome. Neuroendocrinology 1981, 32: 70–77.

    Article  CAS  PubMed  Google Scholar 

  6. Buchfelder M., Brockmeier S., Pichl J., Schrell U., Fahlbush R. Results of dynamic endocrine testing of hypothalamic pituitary function in patients with a primary “empty” sella syndrome. Horm. Metab. Res. 1989, 21: 573–576.

    Article  CAS  PubMed  Google Scholar 

  7. Ishikawa S., Furuse M., Saito T., Okada K., Kuzuya T. Empty sella in control subjects and patients with hypopituitarism. Endocrinol. Jpn. 1988, 35: 665–674.

    Article  CAS  PubMed  Google Scholar 

  8. Impallomeni M., Yeo T., Rudd A., Carr D., Aber V. Investigation of anterior pituitary function in elderly patients over the age of 75. Quart. J. Med. 1987, 63: 505–515.

    CAS  PubMed  Google Scholar 

  9. Pocecco M., De Campo C., Marinoni S., et al. High frequency of empty sella syndrome in children with growth hormone deficiency. Helv. Paediatr. Acta 1989, 43: 295–301.

    CAS  PubMed  Google Scholar 

  10. Cacciari E., Zucchini S., Ambrosetto P., et al. Empty sella in children and adolescents with possible hypothalamic-pituitary disorders. J. Clin. Endocrinol. Metab. 1994, 78: 767–771.

    CAS  PubMed  Google Scholar 

  11. De Boer H., Block G., van Der Veen E.A. Clinical aspects of growth hormone deficiency in adults. Endocr. Rev. 1995, 16: 63–86.

    Article  PubMed  Google Scholar 

  12. Growth Hormone Research Society (GRS). Consensus guidelines for diagnosis and treatment of adults with GH deficiency: summary statement of Growth Hormone Research Society workshop on adult growth hormone deficiency. J. Clin. Endocrinol. Metab. 1998, 83: 379–381.

    Google Scholar 

  13. Hoffman D.M., O’Sullivan A.J., Baxter R.C., Ho K.Y. Diagnosis of growth hormone deficiency in adults. Lancet. 1994, 1: 1064–1068.

    Article  Google Scholar 

  14. Thorner M.O., Bentsson B.A., Ho K.Y., et al. Diagnosis of growth hormone deficiency in adults. J. Clin. Endocrinol. Metab. 1995, 80: 3097–3098.

    CAS  PubMed  Google Scholar 

  15. Svensson J., Johannsson G., Bengtsson B.A. Insulin-like growth factor-I in growth hormone-deficient adults: relationship to population-based normal value, body composition and insulin tolerance test. Clin. Endocrinol. (Oxf.) 1997, 46: 579–586.

    Article  CAS  Google Scholar 

  16. Jones S.L., Trainer P.J., Perry L., Wass J.A.H., Besser G.M., Grossman A. An audit of the insulin tolerance test in adult subjects in an acute investigation unit over one year. Clin. Endocrinol. (Oxf.) 1994, 41: 123–128.

    Article  CAS  Google Scholar 

  17. Alba-Roth J., Muller O.A., Schopohl J., von Werder K. Arginine stimulates growth hormone secretion by suppressing endogenous somatostatin secretion. J. Clin. Endocrinol. Metab. 1988, 67: 1186–1189.

    Article  CAS  PubMed  Google Scholar 

  18. Ghigo E., Aimaretti G., Gianotti L., Bellone J., Arvat E., Camanni F. New approch to the diagnosis of growth hormone deficiency in adults. Eur. J. Endocrinol. 1996, 134: 352–356.

    Article  CAS  PubMed  Google Scholar 

  19. Aimaretti G., Corneli G., Razzore P., et al. Comparison between insulin-induced hypoglicemia and growth hormone (GH)-releasing hormone plus arginine as provocative test for the diagnosis of GH deficiency in adults. J. Clin. Endocrinol. Metab. 1998, 83: 1615–1618.

    CAS  PubMed  Google Scholar 

  20. Bellone J., Aimaretti G., Bellone S., et al. Sequential administration of arginine and arginine plus GHRH to test somatotroph function in short children. J. Endocrinol. Invest. 2000, 23: 97–101.

    Article  CAS  PubMed  Google Scholar 

  21. Valetto M.R., Bellone J., Baffoni C., et al. Reproducibility of the growth hormone response to stimulation with growth hormone-releasing hormone plus arginine during lifespan. Eur. J. Endocrinol. 1996, 135: 568–572.

    Article  CAS  PubMed  Google Scholar 

  22. Gasperi M., Aimaretti G., Scarcello G., et al. Low dose hexarelin and growth hormone (GH)-releasing hormone as a diagnostic tool for the diagnosis of GH deficiency in adults: comparison with insulin-induced hypoglycemia test. J. Clin. Endocrinol. Metab. 1999, 84: 2633–2637.

    CAS  PubMed  Google Scholar 

  23. Liotta A., Maggio C., Giuffrè M., Carta M., Manfrè L.J. Sequential contrast-enhanced magnetic resonance imaging in the diagnosis of growth hormone deficiencies. J. Endocrinol. Invest. 1999, 22: 740–746.

    Article  CAS  PubMed  Google Scholar 

  24. Hall K., Hilding A., Thoren M. Determinants of circulating insulin-like growth factor-I. J. Endocrinol. Invest. 1999, 22: 48–57.

    CAS  PubMed  Google Scholar 

  25. Span J.P.T., Pieters G.F.F.M., Sweep C.G.J., Swinkels L.M.J.W., Smals A.G.H. Plasma IGF-I is a useful marker of growth hormone deficiency in adults. J. Endocrinol. Invest. 1999, 22: 446–450.

    Article  CAS  PubMed  Google Scholar 

  26. Maccario M., Gauna C., Procopio M., et al. Assessment of GH-IGF-I axis in obesity by evaluation of IGF-I levels and the GH response to GHRH+arginine test. J. Endocrinol. Invest. 1999, 22: 424–429.

    Article  CAS  PubMed  Google Scholar 

  27. Casanueva F.F., Villanueva L., Dieguez C, et al. Free fatty acids block growth hormone (GH) releasing hormone-stimulated GH secretion in man directly at the pituitary. J. Clin. Endocrinol. Metab. 1987, 65: 634–642.

    Article  CAS  PubMed  Google Scholar 

  28. Pombo M., Pombo C.M., Astorga R., et al. Regulation of growth hormone secretion by signals produced by the adipose tissue. J. Endocrinol. Invest. 1999, 22: 22–26.

    CAS  PubMed  Google Scholar 

  29. Littley M.D., Shalet S.M., Beardwell C.G., Ahmed S.R., Applegate G., Sutton M.L. Hypopituitarism following external radiotherapy for pituitary tumours in adults. Q. J. Med. 1989, 70: 145–160.

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Endocrinology, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy

    M. Gasperi, E. Cecconi, L. Grasso & E. Martino

  2. Department of Oncology, University of Pisa, Pisa, Italy

    M. Cosottini

  3. Division of Endocrinology, Department of Internal Medicine, University of Turin, Turin, Italy

    G. Aimaretti, C. Baffoni & E. Ghigo

  4. Department of Molecular and Clinical Endocrinology and Oncology, “Federico II” University of Naples, Naples, Italy

    A. Colao, C. Di Somma & G. Lombardi

  5. Division of Endocrinology, University of Messina, Messina, Italy

    S. Cannavò, L. Curtò & F. Trimarchi

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  1. M. Gasperi
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  2. G. Aimaretti
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  3. E. Cecconi
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  4. A. Colao
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  5. C. Di Somma
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  6. S. Cannavò
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  7. C. Baffoni
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  8. M. Cosottini
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  9. L. Curtò
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  10. F. Trimarchi
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  11. G. Lombardi
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  12. L. Grasso
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  13. E. Ghigo
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  14. E. Martino
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Correspondence to M. Gasperi.

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Gasperi, M., Aimaretti, G., Cecconi, E. et al. Impairment of GH secretion in adults with primary empty sella. J Endocrinol Invest 25, 329–333 (2002). https://doi.org/10.1007/BF03344013

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