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Pituitary neuroendocrine tumors and differentiated thyroid cancer: do metabolic and inflammatory risk factors play roles?

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Abstract

Purpose

It is postulated that patients with different types of pituitary neuroendocrine tumors (PitNETs) may present a higher incidence of cancer. Factors underlying individuals becoming overweight, such as insulin resistance, hyperleptinemia, and low-grade inflammation, may play a role in the risk of differentiated thyroid carcinoma (DTC) in such patients. This study aimed to investigate the frequency of and obesity-related risk factors associated with DTC in patients with PitNETs.

Methods

This cross-sectional study involved 149 patients with nonacromegalic PitNETs (AG group), 71 patients with acromegaly (ACRO group), and 156 controls (CG group). All participants underwent insulin and blood glucose measurements with the determination of the homeostatic model assessment-insulin resistance (HOMA-IR) index, leptin, and high-sensitivity C-reactive protein (hsCRP), and they also underwent thyroid ultrasound. Clinically significant nodules were biopsied for subsequent cytopathological evaluation, and participants were operated on when indicated.

Results

Patients in the AG group had high levels of insulin resistance and significantly higher levels of leptin and hsCRP compared with those of patients in the ACRO group. There were no cases of DTC in the AG group; two findings, one incidental, of DTC occurred in the CG group, and three cases of DTC were present in the ACRO group. Acromegaly was associated with DTC after adjusted analysis.

Conclusions

Our findings in patients with nonacromegalic PitNETs do not indicate a high risk for DTC despite the presence of metabolic and inflammatory risk factors for neoplastic events. In contrast, acromegaly promotes a greater risk of DTC.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

The authors thank the CEPEC staff nurses for their logistical support. We are especially grateful to Adriana Guimarães and Patrícia Azevedo for their assistance with data management.

Funding

No funding was received.

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Authors and Affiliations

  1. Service of Endocrinology, Presidente Dutra University Hospital, Federal University of Maranhão (UFMA), São Luís, MA, Brazil

    G. Cortês Nascimento, C. de Maria Ribeiro Veiga Parente, R. S. de Sousa Azulay, V. C. de Carvalho Rocha, S. da Silva Pereira Damianse & M. dos Santos Faria

  2. Clinical Research Center, Presidente Dutra University Hospital, Federal University of Maranhão (UFMA), São Luís, MA, Brazil

    G. Cortês Nascimento, A. G. P. de Araujo Cortês Nascimento, R. S. de Sousa Azulay, V. C. de Carvalho Rocha, S. da Silva Pereira Damianse, M. Magalhães & M. dos Santos Faria

  3. Research Group in Clinical and Molecular Endocrinology and Metabology (ENDOCLIM), São Luís, MA, Brazil

    G. Cortês Nascimento, A. G. P. de Araujo Cortês Nascimento, V. P. Rodrigues, R. S. de Sousa Azulay, V. C. de Carvalho Rocha, S. da Silva Pereira Damianse, M. Magalhães & M. dos Santos Faria

  4. Department of Pathology, Presidente Dutra University Hospital, Federal University of Maranhão (UFMA), São Luís, MA, Brazil

    A. G. P. de Araujo Cortês Nascimento

  5. Department of Morphology, Federal University of Maranhão (UFMA), São Luís, MA, Brazil

    V. P. Rodrigues

  6. Diabetes Unit-Department of Internal Medicine, State University of Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil

    M. B. Gomes

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  1. G. Cortês Nascimento
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Contributions

GCN, MSF and MBG contributed to the study conception and design. Data acquisition, analysis and interpretation were performed by GCN, AGPACN, CMVP, VPR, RSSA, VCCR, SSPD and MM. GCN, VPR, MM and MSF drafted the manuscript. All authors revised the work critically for valuable intellectual content, read and approved the final version to be published, and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to G. Cortês Nascimento.

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Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethics approval

All procedures performed in studies involving human participants were conducted in accordance with the ethical standards of the institutional and/or national research committee (this study was approved by the Research and Ethics Committee of the Presidente Dutra University Hospital of the Federal University of Maranhão under the number 1.258.417) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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This article does not involve any studies with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Cortês Nascimento, G., de Araujo Cortês Nascimento, A.G.P., de Maria Ribeiro Veiga Parente, C. et al. Pituitary neuroendocrine tumors and differentiated thyroid cancer: do metabolic and inflammatory risk factors play roles?. J Endocrinol Invest 44, 735–744 (2021). https://doi.org/10.1007/s40618-020-01357-8

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