Evaluation of Diastolic Dysfunction in Pituitary Adenomas: A Comparative Single-Center Study Among Acromegaly, Prolactinoma, and Nonfunctioning Pituitary Adenomas

Background and Objectives: Pituitary adenomas may be associated with metabolic and cardiovascular abnormalities, but comparative evidence across subtypes is limited. We compared cardiometabolic and echocardiographic profiles, left ventricular diastolic dysfunction (LVDD), and carotid intima-media thickness (CIMT) among patients with prolactinoma, acromegaly, or nonfunctioning pituitary adenoma (NFPA) and healthy controls and investigated factors associated with LVDD. Materials and Methods: This cross-sectional comparative study included 214 participants evaluated between 2016 and 2018: 91 with prolactinoma, 26 with acromegaly, 45 with NFPA, and 52 healthy controls. Participants underwent clinical, biochemical, echocardiographic, and CIMT assessment. LVDD was diagnosed and graded according to the 2016 American Society of Echocardiography (ASE) and European Association of Cardiovascular Imaging (EACVI) recommendations. Factors associated with LVDD were evaluated using multivariable logistic regression. Results: The mean age was 41.3 ± 12.4 years, and 64.5% of participants were women. Acromegaly was associated with the highest fasting glucose, HbA1c, insulin, and homeostasis model assessment of insulin resistance (HOMA-IR) values (all p < 0.001) and, compared with controls, a higher left atrial volume index (LAVI) and average E/e' ratio and lower left ventricular ejection fraction (despite preserved ejection fraction), E/A ratio, and lateral e' velocity. CIMT was higher in NFPA than in prolactinoma. LVDD was present in 21.5% of the cohort and in 5.8%, 19.8%, 46.2%, and 28.9% of the control, prolactinoma, acromegaly, and NFPA groups, respectively (p < 0.001); 84.8% of cases were grade I. Increasing age was independently associated with LVDD (OR 1.265 per year, 95% CI 1.155-1.385; p < 0.001), and diagnostic group was independently associated with LVDD overall (p = 0.004). Compared with controls, adjusted LVDD odds were higher in prolactinoma (OR 10.9, 95% CI 1.34-89.68), acromegaly (OR 167.5, 95% CI 10.3-2721.4), and NFPA (OR 12.0, 95% CI 1.4-104.8). Conclusions: Pituitary adenoma subtypes were associated with distinct cardiometabolic and echocardiographic profiles and a higher prevalence of LVDD than in healthy controls, particularly in acromegaly. Most LVDD cases were grade I, indicating predominantly impaired relaxation. Although age and diagnostic group were associated with LVDD in the adjusted analysis, the wide confidence intervals warrant cautious interpretation and validation in larger cohorts.