Nonalcoholic Fatty Liver Disease and Metabolic Syndrome in Hypopituitary Patients

Increased incidence of cardiovascular mortality and nonalcoholic fatty liver disease (NAFLD) has been reported in hypopituitarism, but previous studies did not correct for obesity in these patients. Therefore, it remained unclear if endocrine deficiency in hypopituitarism is associated with metabolic consequences independent of obesity. This study was designed to determine the burden of cardiovascular disease and NAFLD in hypopituitarism. We performed a retrospective case-control analysis of hypopituitary patients at Veterans Affair Medical center, Memphis, from January 1997 to June 2007. After matching for age, gender, obesity, and race, relevant data were abstracted from the subjects’ records to determine the presence of hypopituitarism, cardiovascular risk factors, and fatty liver disease. Cases and controls were characterized by descriptive statistics and compared using χ2 and Student t tests. Hypopituitary patients exhibited higher prevalence of hypertension- 88% versus 78% (P < 0.03), hypertriglyceridemia-80% versus 70% (P=0.05), low high-density lipoprotein cholesterol-84% versus 70% (P < 0.001), and metabolic syndrome-90% versus 71% (P < 0.001). Patients also had higher mean plasma glucose levels-228 ± 152 versus 181 ± 83mg/dL (P < 0.01). Despite higher preponderance of cardiovascular risk factors in hypopituitary patients, prevalence of cardiovascular morbidity was similar in both groups (P > 0.3). Hypopituitary patients had higher elevations in serum aminotransferase levels and hyperbilirubinemia-24% versus 11% (P < 0.01), as well as higher international normalized ratio (INR) and hypoalbuminemia 40% versus 23% (P < 0.01). There is an increased prevalence of metabolic syndrome and liver dysfunction consistent with NAFLD in hypopituitarism. Although hypopituitary patients had higher prevalence of cardiovascular risk factors than controls, they were not disproportionately affected by cardiovascular disease.