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Boertien TM, Van Someren EJW, Coumou AD, van den Broek AK, Klunder JH, Wong WY, van der Hoeven AE, Drent ML, Romijn JA, Fliers E, Bisschop PH. Compression of the optic chiasm is associated with reduced photoentrainment of the central biological clock. Eur J Endocrinol 2022; 187:809-821. [PMID: 36201161 DOI: 10.1530/eje-22-0527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/04/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Pituitary tumours that compress the optic chiasm are associated with long-term alterations in sleep-wake rhythm. This may result from damage to intrinsically photosensitive retinal ganglion cells (ipRGCs) projecting from the retina to the hypothalamic suprachiasmatic nucleus via the optic chiasm to ensure photoentrainment (i.e. synchronisation to the 24-h solar cycle through light). To test this hypothesis, we compared the post-illumination pupil response (PIPR), a direct indicator of ipRGC function, between hypopituitarism patients with and without a history of optic chiasm compression. DESIGN Observational study, comparing two predefined groups. METHODS We studied 49 patients with adequately substituted hypopituitarism: 25 patients with previous optic chiasm compression causing visual disturbances (CC+ group) and 24 patients without (CC- group). The PIPR was assessed by chromatic pupillometry and expressed as the relative change between baseline and post-blue-light stimulus pupil diameter. Objective and subjective sleep parameters were obtained using polysomnography, actigraphy, and questionnaires. RESULTS Post-blue-light stimulus pupillary constriction was less sustained in CC+ patients compared with CC- patients, resulting in a significantly smaller extended PIPR (mean difference: 8.1%, 95% CI: 2.2-13.9%, P = 0.008, Cohen's d = 0.78). Sleep-wake timing was consistently later in CC+ patients, without differences in sleep duration, efficiency, or other rest-activity rhythm features. Subjective sleep did not differ between groups. CONCLUSION Previous optic chiasm compression due to a pituitary tumour in patients with hypopituitarism is associated with an attenuated PIPR and delayed sleep timing. Together, these data suggest that ipRGC function and consequently photoentrainment of the central biological clock is impaired in patients with a history of optic chiasm compression.
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Affiliation(s)
- Tessel M Boertien
- Amsterdam UMC location University of Amsterdam, Endocrinology and Metabolism, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Endocrinology, Metabolism and Nutrition, Amsterdam, The Netherlands
| | - Eus J W Van Someren
- Netherlands Institute for Neuroscience (NIN), Sleep and Cognition, Amsterdam, The Netherlands
- Amsterdam UMC location VU University, Psychiatry, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Stress & Sleep, Amsterdam, The Netherlands
- VU University, Centre for Neurogenomics and Cognitive Research, Integrative Neurophysiology, Amsterdam, The Netherlands
| | - Adriaan D Coumou
- Amsterdam UMC location University of Amsterdam, Ophthalmology, Amsterdam, The Netherlands
| | - Annemieke K van den Broek
- Amsterdam UMC location University of Amsterdam, Endocrinology and Metabolism, Amsterdam, The Netherlands
| | - Jet H Klunder
- Amsterdam UMC location University of Amsterdam, Endocrinology and Metabolism, Amsterdam, The Netherlands
| | - Wing-Yi Wong
- Amsterdam UMC location University of Amsterdam, Endocrinology and Metabolism, Amsterdam, The Netherlands
| | - Adrienne E van der Hoeven
- Amsterdam UMC location University of Amsterdam, Endocrinology and Metabolism, Amsterdam, The Netherlands
| | - Madeleine L Drent
- Amsterdam Gastroenterology Endocrinology Metabolism, Endocrinology, Metabolism and Nutrition, Amsterdam, The Netherlands
- Amsterdam UMC location VU University, Internal Medicine, Section of Endocrinology, Amsterdam, The Netherlands
| | - Johannes A Romijn
- Amsterdam UMC location University of Amsterdam, Endocrinology and Metabolism, Amsterdam, The Netherlands
- Amsterdam UMC location University of Amsterdam, Internal Medicine, Amsterdam, The Netherlands
| | - Eric Fliers
- Amsterdam UMC location University of Amsterdam, Endocrinology and Metabolism, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Endocrinology, Metabolism and Nutrition, Amsterdam, The Netherlands
| | - Peter H Bisschop
- Amsterdam UMC location University of Amsterdam, Endocrinology and Metabolism, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Endocrinology, Metabolism and Nutrition, Amsterdam, The Netherlands
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Buijs RM, Hurtado-Alvarado G, Soto-Tinoco E. Vasopressin: An output signal from the suprachiasmatic nucleus to prepare physiology and behaviour for the resting phase. J Neuroendocrinol 2021; 33:e12998. [PMID: 34189788 DOI: 10.1111/jne.12998] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/24/2021] [Accepted: 05/31/2021] [Indexed: 01/18/2023]
Abstract
Vasopressin (VP) is an important hormone produced in the supraoptic (SON) and paraventricular nucleus (PVN) with antidiuretic and vasoconstrictor functions in the periphery. As one of the first discovered peptide hormones, VP was also shown to act as a neurotransmitter, where VP is produced and released under the influence of various stimuli. VP is one of the core signals via which the biological clock, the suprachiasmatic nucleus (SCN), imposes its rhythm on its target structures and its production and release is influenced by the rhythm of clock genes and the light/dark cycle. This is contrasted with VP production and release from the bed nucleus of the stria terminalis and the medial amygdala, which is influenced by gonadal hormones, as well as with VP originating from the PVN and SON, which is released in the neural lobe and central targets. The release of VP from the SCN signals the near arrival of the resting phase in rodents and prepares their physiology accordingly by down-modulating corticosterone secretion, the reproductive cycle and locomotor activity. All these circadian variables are regulated within very narrow boundaries at a specific time of the day, where day-to-day variation is less than 5% at any particular hour. However, the circadian peak values can be at least ten times higher than the circadian trough values, indicating the need for an elaborate feedback system to inform the SCN and other participating nuclei about the actual levels reached during the circadian cycle. In short, the interplay between SCN circadian output and peripheral feedback to the SCN is essential for the adequate organisation of all circadian rhythms in physiology and behaviour.
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Affiliation(s)
- Ruud M Buijs
- Departamento de Biología Celular y Fisiología, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, México City, México
| | - Gabriela Hurtado-Alvarado
- Departamento de Biología Celular y Fisiología, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, México City, México
| | - Eva Soto-Tinoco
- Departamento de Biología Celular y Fisiología, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, México City, México
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The functional microscopic neuroanatomy of the human subthalamic nucleus. Brain Struct Funct 2019; 224:3213-3227. [PMID: 31562531 PMCID: PMC6875153 DOI: 10.1007/s00429-019-01960-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 09/14/2019] [Indexed: 01/19/2023]
Abstract
The subthalamic nucleus (STN) is successfully used as a surgical target for deep brain stimulation in the treatment of movement disorders. Interestingly, the internal structure of the STN is still incompletely understood. The objective of the present study was to investigate three-dimensional (3D) immunoreactivity patterns for 12 individual protein markers for GABA-ergic, serotonergic, dopaminergic as well as glutamatergic signaling. We analyzed the immunoreactivity using optical densities and created a 3D reconstruction of seven postmortem human STNs. Quantitative modeling of the reconstructed 3D immunoreactivity patterns revealed that the applied protein markers show a gradient distribution in the STN. These gradients were predominantly organized along the ventromedial to dorsolateral axis of the STN. The results are of particular interest in view of the theoretical underpinning for surgical targeting, which is based on a tripartite distribution of cognitive, limbic and motor function in the STN.
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Vargas-Ortega G, González-Virla B, Balcázar-Hernández L, Nieto-Guzmán O, Garrido-Mendoza AP, Flores-Maya MA, Mendoza-Zubieta V. Cardiovascular Risk and Metabolic Syndrome Characteristics in Patients with Nonfunctional Pituitary Macroadenoma. Int J Endocrinol 2018; 2018:2852710. [PMID: 30224919 PMCID: PMC6129843 DOI: 10.1155/2018/2852710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/08/2018] [Accepted: 07/02/2018] [Indexed: 11/18/2022] Open
Abstract
CONTEXT An elevated incidence of type 2 diabetes and cardiovascular disease (CVD) has been reported in patients with nonfunctional pituitary macroadenoma (NFPMA). There is no information about metabolic syndrome and cardiovascular risk in patients with NFPMA in our population. OBJECTIVE Analyze the metabolic syndrome (MetS) components and estimate cardiovascular risk in patients with NFPMA. DESIGN AND SETTING Retrospective study, at the tertiary care center. PATIENTS AND METHODS 71 patients with NFPMA treated according to a preestablished multimodal protocol. MAIN OUTCOME MEASURES Prevalence of diabetes, hypertension, high cholesterol, obesity, and cardiovascular risk and its relationship with the clinical and biochemical characteristics. RESULTS The prevalence of diabetes, hypertension, high cholesterol, and obesity at diagnosis was 30%, 27%, 48%, and 85% and did not change upon the last visit. The prevalence of MetS changes from 54 to 48% (p = 0.001). NFPMA patients showed a significant increase risk for high total cholesterol (SMR 1.68, 95% CI 1.28-2.17, p = 0.001) and diabetes (SMR 3.19, 95% CI 2.19-4.49, p = 0.01). According to Globorisk, the male gender was an evidence of high CVD before (81% versus 18%, p = 0.01) and after (72% versus 28%, p = 0.01) multimodal treatment. CONCLUSION A high prevalence of cardiovascular and metabolic disease and a high cardiovascular risk were evidenced in patients with NFPMA, especially in men. Risk factors such as the personal history of hypertension and dyslipidemia could explain the foregoing, so the control and treatment of metabolic parameters and cardiovascular risk should be an integral part of the follow-up of these patients.
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Affiliation(s)
- Guadalupe Vargas-Ortega
- Endocrinology Service, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Baldomero González-Virla
- Endocrinology Service, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Lourdes Balcázar-Hernández
- Endocrinology Service, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Oriana Nieto-Guzmán
- Endocrinology Service, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Ana Pamela Garrido-Mendoza
- Endocrinology Service, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Marco Antonio Flores-Maya
- Endocrinology Service, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Victoria Mendoza-Zubieta
- Endocrinology Service, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
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Abstract
Ultimately, almost all patients who are appropriately treated for pituitary tumours enter a chronic phase with control or cure of hormonal excess, adequate treatment of pituitary insufficiency and relief of mass effects. This phase is associated with improvement of initial signs and symptoms, but also with the persistent consequences of the initial disease and associated treatments. Pituitary insufficiency is a common denominator in many of these patients, and is associated with a reduction in quality of life, despite adequate endocrine substitution. Hypothalamic dysfunction can be present in patients previously treated for visual impairments caused by large suprasellar adenomas, or craniopharyngiomas. In addition to hypopituitarism, these patients can have multisystem morbidities caused by altered hypothalamic function, including weight gain and disturbed regulation of sleep-wake cycles. Mortality can also be affected. Patients cured of Cushing disease or acromegaly have chronic multisystem morbidities (in the case of Cushing disease, also affecting mortality) caused by irreversible effects of the previous excesses of cortisol in Cushing disease and growth hormone and insulin-like growth factor 1 in acromegaly. In addition to early diagnosis and treatment of pituitary tumours, research should focus on the amenability of these chronic post-treatment syndromes to therapeutic intervention, to improve quality of life and clinical outcomes.
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Affiliation(s)
- Johannes A Romijn
- Department of Medicine, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, Netherlands
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Pereira AM. Long-term effects of treatment of pituitary adenomas. HANDBOOK OF CLINICAL NEUROLOGY 2016; 124:361-71. [PMID: 25248599 DOI: 10.1016/b978-0-444-59602-4.00024-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Pituitary adenomas can be treated effectively in the vast majority of cases. After successful treatment for pituitary disease, many patients still report reduced quality of life in the presence of persistent morbidity and (slightly) increased mortality. At present, there is an increasing awareness that in many cases long-term remission of functioning or nonfunctioning adenomas does not equal cure. The causes are most probably multifactorial. Hypopituitarism, intrinsic imperfections of surgical or endocrine replacement therapy, but also persistent effects of treatment and of previous hormone excess on the central nervous system all affect long-term morbidity, general well-being, and mortality. This implies that treatment goals for patients with pituitary adenomas will shift from long-term cure to long-term care. Further research is therefore needed to get more insight into each of these factors of influence, such as the extent of reversibility of hormone excess syndromes on cardiovascular risk and behavior. The fact that coping strategies, despite long-term remission, are altered and illness perceptions are affected strongly suggests that long-term care should incorporate self-management interventions that might help to improve quality of life for patients.
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Affiliation(s)
- Alberto M Pereira
- Department of Endocrinology and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, The Netherlands.
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Miller AV, Kavanaugh SI, Tsai PS. Disruption of the Suprachiasmatic Nucleus in Fibroblast Growth Factor Signaling-Deficient Mice. Front Endocrinol (Lausanne) 2016; 7:11. [PMID: 26903947 PMCID: PMC4745264 DOI: 10.3389/fendo.2016.00011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 01/25/2016] [Indexed: 11/13/2022] Open
Abstract
Fibroblast growth factor (Fgf) 8 is essential for the development of multiple brain regions. Previous studies from our laboratory showed that reduced Fgf8 signaling led to the developmental alterations of neuroendocrine nuclei that originated within the diencephalon, including the paraventricular (PVN) and supraoptic (SON) nuclei. To further understand the role of Fgf8 in the development of other hypothalamic nuclei, we examined if Fgf8 and its cognate receptor, Fgfr1, also impact the integrity of the suprachiasmatic nuclei (SCN). The SCN control an organism's circadian rhythm and contain vasoactive intestinal peptide (VIP)-producing neurons as the main input neurons. Mice hypomorphic for Fgf8, Fgfr1, or both were examined for their SCN volume and the number of VIP neurons on postnatal day (PN) 0; adult hypomorphic mice were further examined for SCN function by quantifying SCN neuronal activation using cFos as a marker. On PN0, mice homozygous for Fgf8 hypomorphy displayed the most severe reduction of the SCN volume and VIP neurons. Those heterozygous for Fgf8 hypomorphy alone or Fgf8 combined with Fgfr1 hypomorphy, called double heterozygotes (DH), showed normal SCN volume but significantly reduced VIP neurons, albeit less severely than the homozygotes. Adult wild type, heterozygous Fgf8 hypomorphs (F8 Het), and DH mice were also examined for SCN cFos activation at three time points: 1 h (morning), 6 h (afternoon), and 11 h (evening) after light onset. In F8 Het mice, a significant change in the pattern of cFos immunostaining that may reflect delayed morning SCN activation was observed. Overall, our studies provide evidence supporting that deficiencies in Fgf8 not only impact the structural integrity of the SCN but also the pattern of SCN activation in response to light.
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Affiliation(s)
- Ann V. Miller
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
- *Correspondence: Ann V. Miller,
| | - Scott I. Kavanaugh
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - Pei-San Tsai
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
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Joustra SD, Thijs RD, van den Berg R, van Dijk M, Pereira AM, Lammers GJ, van Someren EJW, Romijn JA, Biermasz NR. Alterations in diurnal rhythmicity in patients treated for nonfunctioning pituitary macroadenoma: a controlled study and literature review. Eur J Endocrinol 2014; 171:217-28. [PMID: 24826835 DOI: 10.1530/eje-14-0172] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Patients treated for nonfunctioning pituitary macroadenomas (NFMAs) have fatigue and alterations in sleep characteristics and sleep-wake rhythmicity frequently. As NFMAs often compress the optic chiasm, these complaints might be related to dysfunction of the adjacent suprachiasmatic nucleus (SCN). We aimed to explore whether indirect indices of SCN functioning are altered in the long term after surgery for NFMAs. METHODS We studied 17 NFMA patients in long-term remission after transsphenoidal surgery, receiving adequate and stable hormone replacement for hypopituitarism, and 17 control subjects matched for age, gender, and BMI. Indirect indices of SCN function were assessed from 24-h ambulatory recordings of skin and core body temperatures, blood pressure, and salivary melatonin levels. Altered melatonin secretion was defined as an absence of evening rise, considerable irregularity, or daytime values >3 pg/ml. We additionally studied eight patients treated for craniopharyngioma. RESULTS Distal-proximal skin temperature gradient did not differ between NFMAs and control subjects, but proximal skin temperature was decreased during daytime (P=0.006). Core body temperature and non-dipping of blood pressure did not differ, whereas melatonin secretion was often altered in NFMAs (OR 5.3, 95% CI 0.9-30.6). One or more abnormal parameters (≥2.0 SDS of control subjects) were observed during nighttime in 12 NFMA patients and during daytime in seven NFMA patients. Similar patterns were observed in craniopharyngioma patients. CONCLUSION Heterogeneous patterns of altered diurnal rhythmicity in skin temperature and melatonin secretion parameters were observed in the majority of patients treated for NFMAs. On a group level, both NFMA and craniopharyngioma patients showed a lower daytime proximal skin temperature than control subjects, but other group averages were not significantly different. The observations suggest altered function of central (or peripheral) clock machinery, possibly by disturbed entrainment or damage of the hypothalamic SCN by the suprasellar macroadenoma or its treatment.
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Affiliation(s)
- S D Joustra
- Center for Endocrine Tumors LeidenDepartment of Endocrinology and MetabolismDepartment of NeurologyLeiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, The NetherlandsStichting Epilepsie Instellingen Nederland (SEIN)Achterweg 5, 2103SW Heemstede, The NetherlandsDepartment of Sleep and CognitionNetherlands Institute for Neuroscience, Meibergdreef 47, 1105BA Amsterdam, The NetherlandsNeuroscience Campus AmsterdamDepartments of Integrative Neurophysiology and Medical Psychology, VU University and Medical Center, De Boelelaan 1117, 1081HZ Amsterdam, The Netherlands
| | - R D Thijs
- Center for Endocrine Tumors LeidenDepartment of Endocrinology and MetabolismDepartment of NeurologyLeiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, The NetherlandsStichting Epilepsie Instellingen Nederland (SEIN)Achterweg 5, 2103SW Heemstede, The NetherlandsDepartment of Sleep and CognitionNetherlands Institute for Neuroscience, Meibergdreef 47, 1105BA Amsterdam, The NetherlandsNeuroscience Campus AmsterdamDepartments of Integrative Neurophysiology and Medical Psychology, VU University and Medical Center, De Boelelaan 1117, 1081HZ Amsterdam, The NetherlandsCenter for Endocrine Tumors LeidenDepartment of Endocrinology and MetabolismDepartment of NeurologyLeiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, The NetherlandsStichting Epilepsie Instellingen Nederland (SEIN)Achterweg 5, 2103SW Heemstede, The NetherlandsDepartment of Sleep and CognitionNetherlands Institute for Neuroscience, Meibergdreef 47, 1105BA Amsterdam, The NetherlandsNeuroscience Campus AmsterdamDepartments of Integrative Neurophysiology and Medical Psychology, VU University and Medical Center, De Boelelaan 1117, 1081HZ Amsterdam, The Netherlands
| | - R van den Berg
- Center for Endocrine Tumors LeidenDepartment of Endocrinology and MetabolismDepartment of NeurologyLeiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, The NetherlandsStichting Epilepsie Instellingen Nederland (SEIN)Achterweg 5, 2103SW Heemstede, The NetherlandsDepartment of Sleep and CognitionNetherlands Institute for Neuroscience, Meibergdreef 47, 1105BA Amsterdam, The NetherlandsNeuroscience Campus AmsterdamDepartments of Integrative Neurophysiology and Medical Psychology, VU University and Medical Center, De Boelelaan 1117, 1081HZ Amsterdam, The Netherlands
| | - M van Dijk
- Center for Endocrine Tumors LeidenDepartment of Endocrinology and MetabolismDepartment of NeurologyLeiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, The NetherlandsStichting Epilepsie Instellingen Nederland (SEIN)Achterweg 5, 2103SW Heemstede, The NetherlandsDepartment of Sleep and CognitionNetherlands Institute for Neuroscience, Meibergdreef 47, 1105BA Amsterdam, The NetherlandsNeuroscience Campus AmsterdamDepartments of Integrative Neurophysiology and Medical Psychology, VU University and Medical Center, De Boelelaan 1117, 1081HZ Amsterdam, The Netherlands
| | - A M Pereira
- Center for Endocrine Tumors LeidenDepartment of Endocrinology and MetabolismDepartment of NeurologyLeiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, The NetherlandsStichting Epilepsie Instellingen Nederland (SEIN)Achterweg 5, 2103SW Heemstede, The NetherlandsDepartment of Sleep and CognitionNetherlands Institute for Neuroscience, Meibergdreef 47, 1105BA Amsterdam, The NetherlandsNeuroscience Campus AmsterdamDepartments of Integrative Neurophysiology and Medical Psychology, VU University and Medical Center, De Boelelaan 1117, 1081HZ Amsterdam, The Netherlands
| | - G J Lammers
- Center for Endocrine Tumors LeidenDepartment of Endocrinology and MetabolismDepartment of NeurologyLeiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, The NetherlandsStichting Epilepsie Instellingen Nederland (SEIN)Achterweg 5, 2103SW Heemstede, The NetherlandsDepartment of Sleep and CognitionNetherlands Institute for Neuroscience, Meibergdreef 47, 1105BA Amsterdam, The NetherlandsNeuroscience Campus AmsterdamDepartments of Integrative Neurophysiology and Medical Psychology, VU University and Medical Center, De Boelelaan 1117, 1081HZ Amsterdam, The NetherlandsCenter for Endocrine Tumors LeidenDepartment of Endocrinology and MetabolismDepartment of NeurologyLeiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, The NetherlandsStichting Epilepsie Instellingen Nederland (SEIN)Achterweg 5, 2103SW Heemstede, The NetherlandsDepartment of Sleep and CognitionNetherlands Institute for Neuroscience, Meibergdreef 47, 1105BA Amsterdam, The NetherlandsNeuroscience Campus AmsterdamDepartments of Integrative Neurophysiology and Medical Psychology, VU University and Medical Center, De Boelelaan 1117, 1081HZ Amsterdam, The Netherlands
| | - E J W van Someren
- Center for Endocrine Tumors LeidenDepartment of Endocrinology and MetabolismDepartment of NeurologyLeiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, The NetherlandsStichting Epilepsie Instellingen Nederland (SEIN)Achterweg 5, 2103SW Heemstede, The NetherlandsDepartment of Sleep and CognitionNetherlands Institute for Neuroscience, Meibergdreef 47, 1105BA Amsterdam, The NetherlandsNeuroscience Campus AmsterdamDepartments of Integrative Neurophysiology and Medical Psychology, VU University and Medical Center, De Boelelaan 1117, 1081HZ Amsterdam, The NetherlandsCenter for Endocrine Tumors LeidenDepartment of Endocrinology and MetabolismDepartment of NeurologyLeiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, The NetherlandsStichting Epilepsie Instellingen Nederland (SEIN)Achterweg 5, 2103SW Heemstede, The NetherlandsDepartment of Sleep and CognitionNetherlands Institute for Neuroscience, Meibergdreef 47, 1105BA Amsterdam, The NetherlandsNeuroscience Campus AmsterdamDepartments of Integrative Neurophysiology and Medical Psychology, VU University and Medical Center, De Boelelaan 1117, 1081HZ Amsterdam, The Netherlands
| | - J A Romijn
- Center for Endocrine Tumors LeidenDepartment of Endocrinology and MetabolismDepartment of NeurologyLeiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, The NetherlandsStichting Epilepsie Instellingen Nederland (SEIN)Achterweg 5, 2103SW Heemstede, The NetherlandsDepartment of Sleep and CognitionNetherlands Institute for Neuroscience, Meibergdreef 47, 1105BA Amsterdam, The NetherlandsNeuroscience Campus AmsterdamDepartments of Integrative Neurophysiology and Medical Psychology, VU University and Medical Center, De Boelelaan 1117, 1081HZ Amsterdam, The Netherlands
| | - N R Biermasz
- Center for Endocrine Tumors LeidenDepartment of Endocrinology and MetabolismDepartment of NeurologyLeiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, The NetherlandsStichting Epilepsie Instellingen Nederland (SEIN)Achterweg 5, 2103SW Heemstede, The NetherlandsDepartment of Sleep and CognitionNetherlands Institute for Neuroscience, Meibergdreef 47, 1105BA Amsterdam, The NetherlandsNeuroscience Campus AmsterdamDepartments of Integrative Neurophysiology and Medical Psychology, VU University and Medical Center, De Boelelaan 1117, 1081HZ Amsterdam, The Netherlands
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Joustra SD, Claessen KMJA, Dekkers OM, van Beek AP, Wolffenbuttel BHR, Pereira AM, Biermasz NR. High prevalence of metabolic syndrome features in patients previously treated for nonfunctioning pituitary macroadenoma. PLoS One 2014; 9:e90602. [PMID: 24608862 PMCID: PMC3946551 DOI: 10.1371/journal.pone.0090602] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 02/01/2014] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Patients treated for nonfunctioning pituitary macroadenoma (NFMA) with suprasellar extension show disturbed sleep characteristics, possibly related to hypothalamic dysfunction. In addition to hypopituitarism, both structural hypothalamic damage and sleep restriction per se are associated with the metabolic syndrome. However, the prevalence of the metabolic syndrome in patients with NFMA is not well established. Our objective was to study the prevalence and risk factors for (components of) the metabolic syndrome in patients treated for NFMA. DESIGN The metabolic syndrome (NCEP-ATP III criteria) was studied in an unselected cohort of 145 NFMA patients (aged 26-88yr, 44% female) in long-term remission after treatment, receiving adequate stable hormone replacement for any pituitary deficiencies. The results were compared to population data of 63,995 Dutch inhabitants by standardization (LifeLines cohort study). RESULTS NFMA patients showed increased risk for reduced HDL-cholesterol (SMR 1.59, 95% CI 1.13-2.11), increased triglyceride levels (SMR 2.31, 95% CI 1.78-2.90) and the metabolic syndrome (SMR 1.60, 95% CI 1.22-2.02), but not for increased blood pressure, waist circumference or hyperglycemia. Preoperative visual field defects independently affected the risk for increased blood pressure (OR 6.5, 95% CI 1.9-22.2), and hypopituitarism was associated with a body mass index - dependent risk for increased waist circumference (OR 1.6, 95% CI 1.2-2.2) and the metabolic syndrome (OR 1.4, 95% CI 1.0-1.9). CONCLUSIONS Patients treated for NFMA are increased at risk for developing the metabolic syndrome, mainly due to decreased HDL-cholesterol and increased triglycerides. Risk factors included hypopituitarism and preoperative visual field defects. Hypothalamic dysfunction may explain the metabolic abnormalities, in addition to intrinsic imperfections of hormone replacement therapy. Additional research is required to explore the relation between derangements in circadian rhythmicity and metabolic syndrome in these patients.
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Affiliation(s)
- Sjoerd D Joustra
- Center for Endocrine Tumors Leiden, Department of Endocrinology and Metabolism, Leiden University Medical Center, Leiden, Netherlands
| | - Kim M J A Claessen
- Center for Endocrine Tumors Leiden, Department of Endocrinology and Metabolism, Leiden University Medical Center, Leiden, Netherlands
| | - Olaf M Dekkers
- Center for Endocrine Tumors Leiden, Department of Endocrinology and Metabolism, Leiden University Medical Center, Leiden, Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | - André P van Beek
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Bruce H R Wolffenbuttel
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Alberto M Pereira
- Center for Endocrine Tumors Leiden, Department of Endocrinology and Metabolism, Leiden University Medical Center, Leiden, Netherlands
| | - Nienke R Biermasz
- Center for Endocrine Tumors Leiden, Department of Endocrinology and Metabolism, Leiden University Medical Center, Leiden, Netherlands
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