|
1
|
Cortês Nascimento G, de Araujo Cortês Nascimento AGP, de Maria Ribeiro Veiga Parente C, Rodrigues VP, de Sousa Azulay RS, de Carvalho Rocha VC, da Silva Pereira Damianse S, Magalhães M, Dos Santos Faria M, Gomes MB. Pituitary neuroendocrine tumors and differentiated thyroid cancer: do metabolic and inflammatory risk factors play roles? J Endocrinol Invest 2021; 44:735-744. [PMID: 32681462 DOI: 10.1007/s40618-020-01357-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 07/07/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE It is postulated that patients with different types of pituitary neuroendocrine tumors (PitNETs) may present a higher incidence of cancer. Factors underlying individuals becoming overweight, such as insulin resistance, hyperleptinemia, and low-grade inflammation, may play a role in the risk of differentiated thyroid carcinoma (DTC) in such patients. This study aimed to investigate the frequency of and obesity-related risk factors associated with DTC in patients with PitNETs. METHODS This cross-sectional study involved 149 patients with nonacromegalic PitNETs (AG group), 71 patients with acromegaly (ACRO group), and 156 controls (CG group). All participants underwent insulin and blood glucose measurements with the determination of the homeostatic model assessment-insulin resistance (HOMA-IR) index, leptin, and high-sensitivity C-reactive protein (hsCRP), and they also underwent thyroid ultrasound. Clinically significant nodules were biopsied for subsequent cytopathological evaluation, and participants were operated on when indicated. RESULTS Patients in the AG group had high levels of insulin resistance and significantly higher levels of leptin and hsCRP compared with those of patients in the ACRO group. There were no cases of DTC in the AG group; two findings, one incidental, of DTC occurred in the CG group, and three cases of DTC were present in the ACRO group. Acromegaly was associated with DTC after adjusted analysis. CONCLUSIONS Our findings in patients with nonacromegalic PitNETs do not indicate a high risk for DTC despite the presence of metabolic and inflammatory risk factors for neoplastic events. In contrast, acromegaly promotes a greater risk of DTC.
Collapse
Affiliation(s)
- G Cortês Nascimento
- Service of Endocrinology, Presidente Dutra University Hospital, Federal University of Maranhão (UFMA), São Luís, MA, Brazil.
- Clinical Research Center, Presidente Dutra University Hospital, Federal University of Maranhão (UFMA), São Luís, MA, Brazil.
- Research Group in Clinical and Molecular Endocrinology and Metabology (ENDOCLIM), São Luís, MA, Brazil.
| | - A G P de Araujo Cortês Nascimento
- Clinical Research Center, Presidente Dutra University Hospital, Federal University of Maranhão (UFMA), São Luís, MA, Brazil
- Research Group in Clinical and Molecular Endocrinology and Metabology (ENDOCLIM), São Luís, MA, Brazil
- Department of Pathology, Presidente Dutra University Hospital, Federal University of Maranhão (UFMA), São Luís, MA, Brazil
| | | | - V P Rodrigues
- Research Group in Clinical and Molecular Endocrinology and Metabology (ENDOCLIM), São Luís, MA, Brazil
- Department of Morphology, Federal University of Maranhão (UFMA), São Luís, MA, Brazil
| | - R S de Sousa Azulay
- Service of Endocrinology, Presidente Dutra University Hospital, Federal University of Maranhão (UFMA), São Luís, MA, Brazil
- Clinical Research Center, Presidente Dutra University Hospital, Federal University of Maranhão (UFMA), São Luís, MA, Brazil
- Research Group in Clinical and Molecular Endocrinology and Metabology (ENDOCLIM), São Luís, MA, Brazil
| | - V C de Carvalho Rocha
- Service of Endocrinology, Presidente Dutra University Hospital, Federal University of Maranhão (UFMA), São Luís, MA, Brazil
- Clinical Research Center, Presidente Dutra University Hospital, Federal University of Maranhão (UFMA), São Luís, MA, Brazil
- Research Group in Clinical and Molecular Endocrinology and Metabology (ENDOCLIM), São Luís, MA, Brazil
| | - S da Silva Pereira Damianse
- Service of Endocrinology, Presidente Dutra University Hospital, Federal University of Maranhão (UFMA), São Luís, MA, Brazil
- Clinical Research Center, Presidente Dutra University Hospital, Federal University of Maranhão (UFMA), São Luís, MA, Brazil
- Research Group in Clinical and Molecular Endocrinology and Metabology (ENDOCLIM), São Luís, MA, Brazil
| | - M Magalhães
- Clinical Research Center, Presidente Dutra University Hospital, Federal University of Maranhão (UFMA), São Luís, MA, Brazil
- Research Group in Clinical and Molecular Endocrinology and Metabology (ENDOCLIM), São Luís, MA, Brazil
| | - M Dos Santos Faria
- Service of Endocrinology, Presidente Dutra University Hospital, Federal University of Maranhão (UFMA), São Luís, MA, Brazil
- Clinical Research Center, Presidente Dutra University Hospital, Federal University of Maranhão (UFMA), São Luís, MA, Brazil
- Research Group in Clinical and Molecular Endocrinology and Metabology (ENDOCLIM), São Luís, MA, Brazil
| | - M B Gomes
- Diabetes Unit-Department of Internal Medicine, State University of Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
| |
Collapse
|
|
2
|
Prevalence of Thyroid Disease in Patients Surgically Treated for Pituitary Disease. J Clin Med 2019; 8:jcm8081142. [PMID: 31370339 PMCID: PMC6722506 DOI: 10.3390/jcm8081142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 07/22/2019] [Accepted: 07/30/2019] [Indexed: 11/30/2022] Open
Abstract
Thyroid disease mainly has a thyroid origin but can occasionally have a pituitary origin. Clinicians face several challenges when these conditions occur together. We aimed to determine the prevalence of thyroid disorders in patients undergoing trans-sphenoidal adenomectomy (TSA) for pituitary disease. We reviewed the medical records of patients undergoing TSA for pituitary disease between 2008 and 2017 at Severance Hospital. Thyroid disorders were categorized using blood test results and medical histories at the time of preoperative evaluation. Among 2202 patients, 44 (2%), 218 (9.9%), and 74 (3.4%) had hyperthyroidism, hypothyroidism, and post-thyroidectomy status before TSA, respectively. Among the 44 patients with hyperthyroidism, 30 (68.2%) had central hyperthyroidism. Among the 218 patients with hypothyroidism, 165 (75.7%) had central hypothyroidism. Central hypothyroidism was more common in patients with adrenocorticotropic hormone-secreting pituitary adenomas (aOR (adjusted odds ratio) 1.85), Rathke’s cleft cysts (aOR 2.34), and craniopharyngiomas (aOR 2.58) (all p < 0.05) than in those with nonfunctioning pituitary adenomas. Contrastingly, thyroid cancer had an increased prevalence in patients with growth hormone- (aOR 3.17), prolactin- (aOR 3.66), and thyroid-stimulating hormone-secreting (aOR 6.28) pituitary adenomas (all p < 0.05). Pituitary disease sometimes accompanies thyroid disorders; their characteristics vary according to the type of pituitary disease.
Collapse
|