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Objective: Primary empty sella (PES) is a frequent anatomical condition rarely causing pituitary dysfunction. We assessed cardiovascular risk in a cohort of PES patients referred to Endocrine Units., Design: The study was performed in three Italian tertiary referral centres. We evaluated pituitary function and cardiovascular risk, on the basis of lipid and glucose metabolism parameters and of Framingham score (FS), in 94 consecutive patients with PES diagnosis and in 94 gender, age and BMI matched controls., Patients: Pituitary function was normal in 30 patients (group A), whereas a single or multiple pituitary hormone deficiency was demonstrated in 64 (group B). Growth hormone deficiency (GHD) was diagnosed in 56, central hypothyroidism in 35, hypogonadotropic hypogonadism in 32 and central hypoadrenalism in 24 cases., Results: Framingham score was higher and glucose and lipid profile were worse in PES patients than in controls. Cardiovascular risk parameters were not different between group A and B. In group B, increased cardiovascular risk was associated with hypothyroidism and hypogonadism, but not with GHD. In group A, cardiovascular risk was higher and FT3 and FT4 levels were lower than in controls. Moreover, PES patients stratified for BMI showed a worse glucose and lipid profile and (in the overweight subgroup) higher FS than matched controls., Conclusions: Primary empty sella patients show increased cardiovascular risk, regardless of BMI. A worse lipid and glucose profile and higher FS were associated with secondary hypothyroidism, even subclinical, as well as hypogonadism., (© 2012 John Wiley & Sons Ltd.)

Context: GH secretion is reduced in obese subjects and increases after body weight loss. It is still unclear if changes in the GH/IGF-I axis after laparoscopic-adjustable silicone gastric banding (LASGB) are associated with changes of body composition., Objective: To analyse the relationships between changes in the GH/IGF-I axis and those of body weight and composition before and after LASGB., Design: Observational, prospective., Setting: University 'Federico II' of Naples (Italy)., Patients: Seventy-two severely obese females (BMI: 44.9 +/- 4.68; mean age: 33.1 +/- 11.34 years) were studied., Main Outcome Measures: GH peak after GHRH plus arginine test, IGF-I, IGFBP-3 and ALS levels, fat mass (FM) and free fat mass (FFM) (by Bioelectrical Impedance Analysis) at baseline and 6 months after LASGB. The change in percentage of individual variables was calculated as well as that of excess of body weight loss (EBWL%). The FM%, FFM% and EBWL% were correlated with peak GH and IGF-I levels changes., Results: At baseline, GH deficiency (GHD) (GH peak = 4.1 microg/l) was found in 22 patients (31%), 16 of them also had IGF-I deficiency (< -2SDS). IGF-I levels were inversely correlated with waist circumference (r = -0.72, P < 0.001) and FM% (r = -0.75, P < 0.001). Post-LASGB the patients were classified as follows: group (1) GH and IGF-I sufficient (n = 44; 61.1%); group (2) GH and IGF-I deficient (n = 14; 19.4%) and group (3) GH sufficient and IGF-I deficient (n = 14; 19.4%). The percentage changes of EWBL (P < 0.05, P = 0.051, respectively) and FM (P < 0.001, P < 0.01, respectively) were lower in groups (2) and (3) than in group (1). At the stepwise linear regression analysis, postoperative IGF-I levels were the strongest determinant of percent changes of FM (P < 0.0001), of FFM (P = 0.009) and of EBWL (P < 0.0001)., Conclusions: IGF-I levels is the most sensitive to unfavourable changes in body composition 6 months after LASGB making investigation of the somatotropic axis useful in the evaluation of bariatric surgery outcomes.