Группа авторов

Metabolic Syndrome Consequent to Endocrine Disorders


Скачать книгу

An excess level of glucocorticoid is also associated with the visceral obesity and fatty liver [83].

      The study from the USA analyzed prevalence of the MetS and NAFLD in adult (predominantly male) hypopituitary patients [3]. Although the study was controlled for obesity, hypopituitary patients exhibited significantly higher prevalence of hypertension (88 vs. 78%), hypertriglyceridemia (80 vs. 70%), and MetS (90 vs. 71%) [3]. Interestingly, patients with hypopituitarism had significantly higher elevations in serum aminotranspherase levels and hyperbilirubinemia as well as higher INR and hypoalbuminemia consistent with the increased prevalence of liver dysfunction in NAFLD and MetS [3]. High prevalence of abnormal liver function in hypopituitary patients may be strongly affected by endocrine deficiency and its metabolic consequences (insulin resistance, visceral fat accumulation), rather than obesity determined by BMI value [3].

      In a Japanese study, prevalence of NAFLD was significantly increased by 6.4-fold in 66 GHD hypopituitary patients compared with the control group [81]. In GHD group serum aminotransferase levels, CRP, and parameters of insulin resistance (IRI and HOMA-IR) were significantly higher than in controls [81]. In GHD patients with NAFLD(+) BMI, visceral fat area, fasting IRI, and HOMA-IR were significantly higher than that in NAFLD(–) GHD patients [81]. HDL cholesterol was lower, while triglycerides and fibrotic marker for the liver type IV collagen were significantly elevated compared to NAFLD(–) GHD group [81]. In 16 (21%) patients with NAFLD, liver biopsy found that 14 had characteristics of NASH [81]. One year of GHRT resulted in significantly decreased aminotranspherase levels and fibrotic markers while, based on histological analysis, steatosis and fibrosis scores in these patients significantly improved [81].

      Interestingly gender difference in the prevalence of fatty liver disease (it is much more common in men) was abolished by hypopituitarism and GHD [82]. Fatty liver disease was more common in patients with more severe hypopituitarism, obesity, and MetS and etiology of craniopharyngeoma and non-functioning adenoma compared to other etiologies of hypopituitarism [81].

      Impact of Other Hormone Deficiencies on MetS in Patients with Hypopituitarism

      GC and Metabolic Phenotype

      Thus GHRT suppresses 11-β hydroxysteroid dehydrogenase type 1 activity thereby unmasking low adrenal reserve, leading to overt central hypocorticism which has to be replaced [86].

      Thyroxin and Metabolic Phenotype