Mersebach Henriette, Klose Marianne, Svendsen Ole L, Astrup Arne, Feldt-Rasmussen Ulla
Department of Endocrinology, Copenhagen University Hospital 9, Blegdamsvej DK-2100 Copenhagen, Denmark.
Obes Res. 2004 Nov;12(11):1835-43. doi: 10.1038/oby.2004.228.
The high prevalence of obesity and cardiovascular risk factors in hypopituitarism affirms the need for effective weight loss intervention. In this study, we investigated the combined effect of sibutramine, diet, and exercise in obese hypopituitary patients (HPs).
In an open-label prospective intervention trial, 14 obese well-substituted nondiabetic HPs and 14 matched simple obese controls were allocated to 11-month treatment with sibutramine (10 to 15 mg), diet (600 kcal/d deficit), and exercise. Anthropometric indices and body composition (obtained from DXA scan) were assessed monthly for the first 5 months and thereafter every second month for the next 6 months.
Mean (+/-SD) weight loss at 11 months was 11.3 +/- 4.8 kg in patients vs. 10.7 +/- 4.7 kg in controls. The HPs exhibited the same improvements in body composition, waist circumference, blood lipids, and fasting glucose as the simple obese. In a multivariate model, baseline weight, duration of growth hormone replacement therapy, and duration of pituitary disease explained 79% (p = 0.001) of the variation in weight loss at 4 months in the HPs. Only baseline weight and waist circumference could predict weight loss at 11 months.
HPs are not resistant to weight loss therapy. Almost all will achieve at least 5% weight loss, and 60% can lose >10% weight within 11 months. However, the long-term effect on risk factors associated with type 2 diabetes and cardiovascular disease as well as on mortality needs to be established.
垂体功能减退症患者中肥胖和心血管危险因素的高患病率表明需要进行有效的减肥干预。在本研究中，我们调查了西布曲明、饮食和运动对肥胖垂体功能减退症患者（HPs）的联合作用。
在一项开放标签的前瞻性干预试验中，14名肥胖且替代治疗良好的非糖尿病HPs患者和14名匹配的单纯肥胖对照者被分配接受为期11个月的西布曲明（10至15毫克）、饮食（每日热量摄入减少600千卡）和运动治疗。在最初的5个月中每月评估人体测量指标和身体成分（通过双能X线吸收法扫描获得），此后在接下来的6个月中每两个月评估一次。
11个月时患者的平均（±标准差）体重减轻为11.3±4.8千克，而对照组为10.7±4.7千克。HPs患者在身体成分、腰围、血脂和空腹血糖方面的改善与单纯肥胖者相同。在多变量模型中，基线体重、生长激素替代治疗的持续时间和垂体疾病的持续时间解释了HPs患者4个月时体重减轻变化的79%（p = 0.001）。只有基线体重和腰围可以预测11个月时的体重减轻。
HPs患者对减肥治疗并非抵抗。几乎所有患者在11个月内至少能减重5%，60%的患者能减重超过10%。然而，对与2型糖尿病和心血管疾病相关的危险因素以及死亡率的长期影响仍有待确定。
