Variables showing significant or near-significant associations ( p ≤ 0.05) were subsequently included in multivariate models to adjust for potential confounders, including adiposity indices (BMI SDS, WHR), biochemical markers of metabolic syndrome (HDL cholesterol, triglycerides, insulin), cranial radiotherapy exposure, and the number of pituitary deficiencies.
Nevertheless, the persistence of a negative trend between IGF-1 SDS and RHI supports the hypothesis that IGF-1 deficiency may play an independent role in endothelial dysfunction.
While BMI differences did not reach statistical significance, a clear upward trend was evident in untreated patients, consistent with previous studies reporting increased total adiposity in GHD due to impaired lipolysis and reduced energy expenditure [ 50 , 51 ].