Alterations in Diurnal Rhythmicity in Patients Treated for Nonfunctioning Pituitary Macroadenoma; A Controlled Study and Literature Review

Presentation Number: SAT-0651
Date of Presentation: June 21st, 2014

Sjoerd D. Joustra*1, Roland D. Thijs2, Rosa van den Berg3, Marieke van Dijk3, Alberto M. Pereira1, Gert J. Lammers2, Eus J.W. van Someren4, Hans A. Romijn3 and Nienke R. Biermasz3
1Leiden University Medical Center, Leiden, Netherlands, 2Leiden University Medical Center, 3Leiden University Medical Center, Netherlands, 4VU University and Medical Center, Amsterdam


Context: Patients treated for nonfunctioning pituitary macroadenoma (NFMA) frequently have fatigue and alterations in sleep characteristics and sleep-wake rhythmicity. Since NFMA often compress the optic chiasm, these complaints might be related to dysfunction of the adjacent suprachiasmatic nucleus (SCN).

Objective: To explore whether indirect indices of SCN functioning are altered in the long-term after surgery for NFMA.

Methods: We studied 17 NFMA patients in long-term remission after transsphenoidal surgery, receiving adequate and stable hormone replacement for hypopituitarism, and 17 controls matched for age, gender, and BMI. Indirect indices of SCN function were assessed from ambulatory 24-hour recordings of skin and core body temperature, blood pressure, and salivary melatonin levels. Altered melatonin secretion was defined as absent evening rise, considerable irregularity, or daytime values >3 pg/ml. We additionally studied 8 patients treated for craniopharyngioma.

Results: Distal-proximal skin temperature gradient did not differ between NFMA and controls, 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 NFMA (OR 5.3, 95%CI 0.9–30.6). One or more abnormal parameters (≥2.0 SD score of controls) were observed during nighttime in twelve and during daytime in seven NFMA patients. Similar patterns were observed in craniopharyngioma patients.

Conclusion: The majority of patients previously treated for NMFA showed signs of altered diurnal rhythms in skin temperature and/or melatonin secretion. These observations suggest that suprasellar tumors may persistently affect diurnal regulation of physiological rhythms, possibly through effects on the SCN.


Nothing to Disclose: SDJ, RDT, RV, MV, AMP, GJL, EJWV, HAR, NRB