Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 14, 2019; 25(14): 1741-1752
Published online Apr 14, 2019. doi: 10.3748/wjg.v25.i14.1741
Clinical characteristics of non-alcoholic fatty liver disease in Chinese adult hypopituitary patients
Xian-Xian Yuan, Hui-Juan Zhu, Hui Pan, Shi Chen, Ze-Yu Liu, Yue Li, Lin-Jie Wang, Lin Lu, Hong-Bo Yang, Feng-Ying Gong
Xian-Xian Yuan, Hui-Juan Zhu, Hui Pan, Shi Chen, Lin-Jie Wang, Lin Lu, Hong-Bo Yang, Feng-Ying Gong, Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission of the People's Republic of China, The Translational Medicine Center of Peking Union Medical College Hospital, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
Ze-Yu Liu, Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
Yue Li, Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
Author contributions: All authors helped to perform the research; Zhu HJ conceived and designed the project; Pan H, Gong FY, and Zhu HJ contributed to the project management; Chen S, Wang LJ, Lu L, and Yang HB took part in the collection of clinical samples; Yuan XX and Liu ZY took part in the statistical analysis; Yuan XX and Zhu HJ wrote the manuscrip; and Li Y took part in the revision of the manuscript.
Supported by the National Key Program of Clinical Science, No. WBYZ 2011-873; the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences, No. 2016YFC0901500; and the Special Research Fund for Central Universities, Peking Union Medical College, No. 2017PT31004.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Peking Union Medical College Hospital (No. JS1233).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained from the Electronic Medical Record of Peking Union Medical College Hospital.
Conflict-of-interest statement: There is no conflict of interest regarding the work presented in this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Hui-Juan Zhu, MD, Professor, Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission of the People's Republic of China, The Translational Medicine Center of Peking Union Medical College Hospital, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1, Shuaifuyuan, Dongcheng District, Beijing 100730, China. shengxin2004@163.com
Telephone: +86-10-69155073 Fax: +86-10-69155073
Received: January 13, 2019
Peer-review started: January 14, 2019
First decision: February 13, 2019
Revised: March 13, 2019
Accepted: March 15, 2019
Article in press: March 16, 2019
Published online: April 14, 2019
Processing time: 91 Days and 16.2 Hours
ARTICLE HIGHLIGHTS
Research background

Non-alcoholic fatty liver disease (NAFLD) is a major global health problem with a substantial rise in prevalence over the last decades. Patients with hypothalamic-pituitary disease have the features of central obesity, insulin resistance, and dyslipidemia, and there is an increased prevalence of liver dysfunction consistent with NAFLD in this population. Growth hormone deficiency (GHD) has been considered as an important contributing factor to these metabolic changes in hypopituitary patients. However, the causes of hypopituitarism in the reported studies varied, and combined pituitary hormone deficiency, including central diabetes insipidus, was more common in this population. This retrospective cross-sectional study was performed to analyze clinical characteristics of NAFLD in Chinese adult hypopituitary/panhypopituitary patients, and to explore the risk factors that lead to rapid progression to cirrhosis.

Research motivation

The research motivation of the present study was to identify possible risk factors related to NAFLD in patients with hypopituitarism by summarizing the characteristics of NAFLD in this patient population, in order to prevent and delay the occurrence and progression of NAFLD in patients with hypopituitarism in future.

Research objectives

The main objectives of the present study were to analyze clinical characteristics of NAFLD in Chinese adult hypopituitary/panhypopituitary patients, and to explore the risk factors that lead to rapid progression to cirrhosis. Additional studies are required to research the mechanism of rapid progression of NAFLD to cirrhosis in hypopituitary patients.

Research methods

The present study is a retrospective cross-sectional observational study. A total of 50 adult Chinese patients with hypopituitarism and/or panhypopituitarism were enrolled. The data were extracted from the medical records, including patients’ characteristics, diagnosis and treatment, biochemical and hormonal tests, and abdominal ultrasound. And then statistical analysis was performed.

Research results

Fifty-four percent of hypopituitary patients in this study were diagnosed with NAFLD, and seven patients were cirrhotic, which was significantly higher than that of the general population. Body mass index (BMI) and homeostasis model assessment of insulin resistance (HOMA-IR) of the cirrhotic patients were significantly higher than those of the patients without NAFLD. Moreover, plasma osmolality and serum sodium concentration of the cirrhotic patients were significantly higher than those of the NAFLD patients, and fasting insulin concentration was positively associated with plasma osmolality in patients with NAFLD, following adjustment for gender, age, and BMI.

Research conclusions

The present study demonstrated a high prevalence of NAFLD and cirrhosis in patients with hypopituitarism. Hypopituitary patients with cirrhosis exhibited significantly higher BMI and HOMA-IR compared with those without NAFLD. In addition, fasting insulin concentration was positively associated with plasma osmolality in patients with NAFLD, following adjustment for gender, age, and BMI. Moreover, we report for the first time that plasma osmolality and serum sodium levels of hypopituitary patients with cirrhosis were significantly higher than those of hypopituitary patients with NAFLD. Additional studies are required to confirm that hyperosmolality may be a significant contributor to the rapid progression of NAFLD in hypopituitary patients.

Research perspectives

There is a high prevalence of NAFLD and cirrhosis in patients with hypopituitarism, but the factors that lead to rapid progression to cirrhosis are not clear. Further studies are needed to determine whether hyperosmolality contributes to the deterioration of NAFLD in hypopituitary patients.