Prevalence of GH and other anterior pituitary hormone deficiencies in adults with nonsecreting pituitary microadenomas and normal serum IGF-1 levels

  1. Kevin C. J. Yuen1,
  2. David M. Cook1,
  3. Prem Sahasranam2,
  4. Pragnesh Patel2,
  5. David E. Ghods2,
  6. Hrayr K. Shahinian3,
  7. Theodore C. Friedman2

Article first published online: 25 JAN 2008

DOI: 10.1111/j.1365-2265.2008.03201.x

Issue

Clinical Endocrinology

Clinical Endocrinology

Volume 69, Issue 2, pages 292–298, August 2008

Additional Information

How to Cite

Yuen, K. C. J., Cook, D. M., Sahasranam, P., Patel, P., Ghods, D. E., Shahinian, H. K. and Friedman, T. C. (2008), Prevalence of GH and other anterior pituitary hormone deficiencies in adults with nonsecreting pituitary microadenomas and normal serum IGF-1 levels. Clinical Endocrinology, 69: 292–298. doi: 10.1111/j.1365-2265.2008.03201.x

Author Information

  1. 1

    Department of Endocrinology, Oregon Health and Science University, Portland, OR 97239–3098, USA,

  2. 2

    Division of Endocrinology, Metabolism and Molecular Medicine, The Charles Drew University of Medicine and Science, Los Angeles, CA 90059, USA and

  3. 3

    Skull Base Institute, Los Angeles, CA 90048, USA

* Dr Kevin C.J. Yuen, Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Mailcode L607 Portland, OR 97239–3098, USA. Tel.: +1 503 4940175; Fax: +1 503 4946990; E-mail: yuenk@ohsu.edu

Publication History

  1. Issue published online: 15 JUL 2008
  2. Article first published online: 25 JAN 2008
  3. (Received 14 December 2007; returned for revision 2 January 2008; finally revised 21 January 2008; accepted 21 January 2008)

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Summary

Objective  GH is usually the first pituitary hormone to be affected following a pathological insult to the pituitary; however, data on the prevalence of GH deficiency in patients with nonsecreting pituitary microadenomas and normal serum IGF-1 levels are scarce. This study aims to evaluate the prevalence of GH and other anterior pituitary hormone deficiencies, and to determine whether microadenomas per se could be associated with reduced GH response rates to GHRH–arginine stimulation.

Design  Analytical, retrospective, two-site case-control study.

Patients and methods  Thirty-eight patients with nonsecreting pituitary microadenomas (mean size 4·2 mm) and normal serum IGF-1 levels were studied. Anterior pituitary function testing, including the GHRH–arginine test to examine GH reserve, was performed in all patients. Serum IGF-1 levels and peak GH levels in the patients that passed the GHRH–arginine test were compared with 22 age- and BMI-matched healthy controls.

Results  Nineteen patients (50%) failed the GHRH–arginine test and had higher body mass index (BMI) than those that passed the GHRH–arginine test and healthy controls. Peak GH levels in patients that passed the GHRH–arginine test were lower compared to healthy controls and 19 patients (50%) had at least one other pituitary hormone deficit. A negative correlation (r = –0·42, P < 0·01) between peak GH levels and BMI was identified, but no correlations were found between peak GH and serum IGF-1 levels.

Conclusions  Our data demonstrated that a substantial number of patients with nonsecreting pituitary microadenomas failed the GHRH–arginine test despite normal serum IGF-1 levels, and had at least one other pituitary hormone deficiency, suggesting that nonsecreting microadenomas may not be clinically harmless. We therefore recommend long-term follow-up with periodic basal pituitary function testing, and to consider dynamic pituitary testing should clinical symptoms arise in these patients.

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