Abstract
IntroductionAcromegaly is frequently associated with impaired glucose tolerance and/or diabetes. To evaluate the relationship between glucose metabolism and acromegaly disease, we evaluated 269 consecutive patients from two referral centres.MethodsClinical presentation, pituitary tumor size and invasiveness, and pituitary pathology were captured in a dedicated database.Results131 women and 138 men with a mean age of 53.8 years were included. Of these, 201 (74.7%) presented with a macroadenoma and 18 (6.7%) with a microadenoma. Radiographic invasion was present in 91 cases (33.8%). Mean tumor diameter was 1.86 cm (0.2–4.6). Pituitary histopathologic findings revealed pure GH-producing somatotroph adenomas (SA) in 147 patients, prolactin-production by mixed lactotroph (LA) and SA or mammosomatotroph adenoma (MSA) in 46 [22.4%], acidophil stem cell adenoma in 6 [2.9%], and other diagnoses in 6 [2.9%]. Medical treatment included octreotide in 96 [36.9%] and in combination with pegvisomant or dopamine agonists in 63 [24.2%]. Nearly 80% of patients achieved IGF-1 normalization. Importantly, patients with pure somatotroph adenomas were significantly more likely to present with abnormal glucose metabolism [48.7%] than those with mixed adenomas [9.7%] [p<0.001] independent of GH/IGF-1 levels or tumor invasiveness. Abnormal glucose metabolism and pituitary pathology also remained linked following IGF-1 normalization. Moreover patients with pure SA and abnormal glucose metabolism were significantly (p<0.001) less likely to achieve disease remission despite the same therapeutic strategies. Conversely, patients with mixed adenomas were more likely (OR: 2.766 (95% CI: 1.490–5.136) to achieve disease remission.ConclusionsPatients with pure somatotroph adenomas are more likely than those with mixed adenomas to exhibit abnormal glucose metabolism.
Highlights
Is frequently associated with impaired glucose tolerance and/or diabetes
Baseline IGF-1 was 835.2 mg/L (34.4) [Mean (SE)] for macroadenomas compared with 678.3 mg/L (38.2) for those with microadenomas (p = 0.044)
IGF-1 levels showed no significant difference between pure somatotroph adenomas (SA) and mixed adenomas either at baseline or at last visit
Summary
Is frequently associated with impaired glucose tolerance and/or diabetes. Aside from the effects of GH and IGF-1 directly on peripheral tissues, morbidity and mortality of patients with this disease is strongly associated with diabetes mellitus, hypertension, and cardiovascular disease [1,2]. Controlled acromegaly is associated with multiple co-morbidities, the most relevant, being cardiovascular, respiratory, rheumatologic, neuropsychiatric, neoplastic and metabolic [3,4,5,6]. Tighter degrees of acromegaly control using a GH antagonist [11,12,13] appear to favourably impact glucose tolerance. The factors underlying this response are yet to be determined
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