Preoperative Oral Glucose Tolerance Test Research Articles

Predictors and Weight Impact of Postbariatric Hypoglycemia after Roux-en-Y Gastric Bypass Surgery: A Prospective Observational Cohort Study

BackgroundPostbariatric hypoglycemia (PBH) is a challenging condition affecting quality of life of patients after bariatric surgery. However, its incidence and predictive factors remain debated. ObjectivesTo determine the incidence of PBH, identify predictors of PBH and assess its association with weight trajectory after bariatric surgery. SettingUniversity Hospital. MethodsProspective observational cohort study including 222 non-diabetic patients who underwent Roux-en-Y gastric bypass (RYGB) between 2014-2021, had an oral glucose tolerance test (OGTT) and/or A1C (glycated hemoglobin) measurement prior to surgery and were followed for at least 12 months. Diagnosis of PBH was made when symptoms of hypoglycemia were accompanied by a postprandial plasma glucose level < 3.9 mmol/l or a glycemia < 3.9 mmol/l during continuous glucose monitoring, with resolution of symptomatology after carbohydrate consumption. Univariable and multivariable logistic regression analyses were performed to identify factors associated with PBH. ResultsOut of 222 patients, 71 (32%) were diagnosed with PBH. The highest incidence rate was observed at 2 years post-bariatric surgery with a cumulative incidence of 26.5%. Predictive factors for higher risk of PBH were younger age at surgery (OR = 0.97; 95% CI: 0.94-0.99; p=0.049) and early dumping syndrome (OR = 3.05; 95% CI: 1.62-6.04; p=0.0008). In multivariable logistic regression, higher glycemia at 2-hours during pre-operative OGTT was associated with lower risk of PBH (OR=0.8; 95% CI: 0.63-0.98; p=0.04). PBH was not associated with weight trajectory after surgery in our cohort. ConclusionsYounger age at time of surgery and lower blood glucose at 120 min during preoperative OGTT are risk factors for PBH. Early dumping syndrome is significantly associated with PBH and could be used as a red flag to help identify patients at risk of PBH.

PD31-11 MYOSTEATOSIS AS A NOVEL PREDICTOR OF NEW-ONSET DIABETES MELLITUS AFTER KIDNEY TRANSPLANTATION

You have accessJournal of UrologyCME1 Apr 2023PD31-11 MYOSTEATOSIS AS A NOVEL PREDICTOR OF NEW-ONSET DIABETES MELLITUS AFTER KIDNEY TRANSPLANTATION Takahito Wakamiya, Shimpei Yamashita, Kazuro Kikkawa, Yasuo Kohjimoto, and Isao Hara Takahito WakamiyaTakahito Wakamiya More articles by this author , Shimpei YamashitaShimpei Yamashita More articles by this author , Kazuro KikkawaKazuro Kikkawa More articles by this author , Yasuo KohjimotoYasuo Kohjimoto More articles by this author , and Isao HaraIsao Hara More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003324.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: No reports have shown an association between myosteatosis, the decline in the quality of skeletal muscle due to increased fat infiltration, and new-onset diabetes mellitus after transplantation (NODAT). We examine whether myosteatosis is a predictor of NODAT. METHODS: The study included 334 patients who underwent renal transplantation between January 2006 and March 2021. We excluded 27 patients younger than 18 years, 85 patients with diabetic nephropathy, history of diabetes, or diabetic type diagnosed by preoperative oral glucose tolerance test, 3 patients with early renal function loss, and finally, 219 patients were examined. Presurgical non-contrast CT images were used to evaluate sarcopenia and myosteatosis. To evaluate sarcopenia, the psoas muscle index (PMI) in cm2/m2 was calculated by normalizing the total area of the psoas muscle at level L3 by the square of the patient’s height. To evaluate myosteatosis, the average total psoas density (ATPD) in HU was also calculated as an average of the entire left and right psoas muscle density. We investigated whether preoperative skeletal muscle depletion including sarcopenia and myosteatosis is a new risk factor in addition to the previously reported risk factors for NODAT. RESULTS: Median recipient age and BMI were 45 years and 21.1 kg/m2, respectively, and 123 patients (56%) were male. The most common primary disease was chronic glomerulonephritis in 96 patients (43.8%), followed by IgA nephropathy in 40 patients (18.3%) and polycystic kidney disease in 16 patients (7.3%). Preoperative impaired glucose tolerance (IGT) was present in 58 patients (27%) and NODAT in 30 patients (14%), with median PMI and ATPD of 6 cm2/m2 and 41 HU, respectively. In univariate analysis of factors predicting NODAT, recipient age≥45 years (p<0.01), BMI≥25 kg/m2 (p<0.01), with IGT (p<0.01), ATPD<41.9HU (p=0.01); in multivariate analysis, BMI≥25 kg/m2 (p<0.01), with IGT (p<0.01) and ATPD<41.9 HU (p=0.03) were significant risk factors, respectively (Table 1). The incidence rates of NODAT were 3.7% with no risk factor, 10% with one risk factor, 33% with two risk factors, and 60% with three risk factors, respectively. The model effectively stratified patients with NODAT according to the number of risk factors (p<0.01). CONCLUSIONS: Myosteatosis is a new risk factor predicting NODAT. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e905 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Takahito Wakamiya More articles by this author Shimpei Yamashita More articles by this author Kazuro Kikkawa More articles by this author Yasuo Kohjimoto More articles by this author Isao Hara More articles by this author Expand All Advertisement PDF downloadLoading ...

The effect of bariatric surgery on the expression of Growth Differentiation Factor-15/Macrophage-Inhibitory Cytokine-1 (GDF-15/MIC-1) in rat.

Reduced appetite and loss of preference to nutrition dense high-fat diet are present after bariatric surgery. But the mechanism responsible for these changes in biological activities remains unclear. Similar changes in biological activities have been observed with growth/differentiation factor-15/macrophage-inhibitory cytokine-1 (GDF-15/MIC-1) treatment alone. To assess the effect of bariatric surgery on GDF-15/MIC-1expression and circulating level in rodent model. The Affiliated Hospital of Xuzhou Medical University, Xuzhou Jiangsu 221,006, P. R. China. Among 40 fatty Sprague-dawley (SD) rats, 30 randomly receive low-dose STZ to induced diabetes and were randomly assigned to Roux en Y gastric bypass (RYGB, n = 10), Sleeve gastrectomy (SG, n = 10), and SHAM (n = 10). The remaining fatty SD rats were assigned to Normal control (NC, n = 10). Rats were followed for 8weeks postoperatively. Circulating levels of GDF15 and tissue (gastrointestinal and liver) expression were assessed after surgery. Preoperative oral glucose tolerance test (OGTT), and Insulin tolerance test (ITT) were reassessed postoperatively. Changes in bodyweight and food intake were also recorded. Bariatric surgery significantly increased circulating plasma level of GDF15 (p < 0.05). Postoperatively, tissue expression of GDF15 was significantly higher in the stomach pouch, jejunum, and ileum of rats in the RYGB group as well as ileum of rats in the SG group compared to Sham and NC (p < 0.05). Higher Expression of GDF15 in the stomach pouch of the SG group was not statistically significant compared to the stomach of Sham and NC group. GDF15 expression in the liver was significantly less in the RYGB group (p < 0.05). Bariatric surgery significantly increases circulating levels and gastrointestinal tissue expression of GDF15. Given that GDF15 is an important regulator of energy homeostasis, further studies are needed to ascertain the relevance in bariatric surgery.

The effect of sleeve ablation of gastric mucosa on body weight and glucose homeostasis in Sprague-Dawley rat model.

The gastric mucosa is an important endocrine organ, most of which is resected in sleeve gastrectomy (SG). The effect of removing most of the gastric mucosa has not been studied. To assess the effect of ablating the gastric mucosa (an area proportional to that in SG), on obesity and diabetes in a rat model. The Affiliated Hospital of Xuzhou Medical University in Xuzhou Jiangsu, P. R. China. Among 34 fatty Sprague-Dawley rats, 26 randomly received low-dose streptozotocin (STZ) to induce diabetes and then were randomly assigned to gastric mucosa ablation (GMA, n = 10), sleeve gastrectomy (SG, n = 8), and sham (n = 8) groups. The remaining normal fatty rats were assigned to the non-diabetic gastric mucosa ablation (nGMA, n = 8) group. In the GMA groups, the gastric mucosa was thermally ablated using electrocautery. Rats were followed for 8 weeks postoperatively. Preoperative oral glucose tolerance test (OGTT), insulin tolerance test (ITT), and mixed meal tolerance test (MMTT) were repeated at designated time points postoperatively. Changes in body weight, food intake, and fasting blood glucose were also recorded. Fasting ghrelin concentration and area under curve (AUC) decreased significantly (P < .05) in the GMA groups and the SG group after surgery. Gastrin concentration remained unchanged in SG but decreased significantly in the GMA groups after surgery. Significantly increased GLP-1 AUC was found in the GMA groups and the SG group postoperatively. The decrease in fasting blood glucose did not differ significantly between the diabetic GMA and SG groups after surgery. Glucose AUC during OGTT in both SG and diabetic GMA groups was decreased significantly from the preoperative level, but the decreased glucose AUC in the SG group was significantly greater (P < .05). The decrease in body weight and food intake in the SG group was significantly greater than in the GMA groups. Ablation of most of the gastric mucosa along the greater curvature is effective in weight loss and glycemic control in a rodent model.

Characteristics of preoperative steroid profiles and glucose metabolism in patients with primary aldosteronism developing adrenal insufficiency after adrenalectomy

Treatment of choice in patients with unilateral aldosterone producing adenoma (APA) is adrenalectomy. Following surgery, most patients retain normal adrenal function, while some develop adrenal insufficiency (AI). To facilitate early detection and treatment of AI, we aimed to identify variables measured pre-operatively that are associated with post-operative AI. Variables obtained from 66 patients before and after surgery included anthropometrical data, clinical chemistry, endocrine work-up. LC–MS/MS steroid hormone profiles from tests before surgery (ACTH-stimulation, saline infusion, dexamethasone suppression) were obtained. Based on 78 variables, machine-learning methods were used in model fitting for classification and regression to predict ACTH-stimulated cortisol after surgery. Among the 78 variables, insulin concentration during pre-operative oral glucose tolerance test (OGTT) correlated positively, and dexamethasone suppressed glucocorticoids correlated negatively with ACTH-stimulated cortisol after surgery. Inclusion of LC–MS/MS measurements allowed construction of better models associated with the occurrence of AI in the training data, but did not allow reliable prediction in cross-validation. Our results suggest that glucocorticoid co-secretion (low insulin during pre-operative OGTT and insufficient suppression of glucocorticoids following dexamethasone) are correlated with the development of post-operative AI. Addition of steroid profiles improved the accuracy of prediction, but cross validation revealed lack of reliability in the prediction of AI.

Changes in glucose tolerance after pancreatectomy in patients with pancreatic ductal adenocarcinoma.

668 Background: Diabetes mellitus (DM) is reported to be related to pancreatic ductal adenocarcinoma (PDAC). Long-standing DM is a risk factor for PDAC, meanwhile, quite a few patients with PDAC develop DM as a paraneoplastic disorder and some papers reported that DM affected prognosis for PDAC. In this study, we investigated pre- and post-operative glucose tolerance in patients with pancreatectomy for PDAC or other disease. Methods: This single-center prospective study included 69 patients with pancreatectomy (40 pancreaticoduodenectomy (PD) and 29 distal pancreatectomy (DP) ) who received 75-g oral glucose tolerance test (OGTT) and glucagon test pre- and one month postoperatively. Plasma glucose, insulin, and C-peptide (CPR) at 0-, 30-, 60-, and 120-min during OGTT; and 0- and 6-min during glucagon test were obtained. These data and survival outcomes were analyzed. Results: There were 20 (29%) PDAC patients: 12 (30%) in PD group and eight (28%) in DP group. Nine patients with PDAC (45%) and seven patients (18%) without PDAC demonstrated DM type in preoperative OGTT. After pancreatectomy, 11 patients (55%) with PDAC and seven patients (15%) without PDAC experienced improvement in OGTT (P=0.0005). Greater improvement in homeostasis model assessment insulin resistance that were obtained by OGTT and used to measure insulin resistance, was noted after surgery in PDAC patients compared with non-PDAC patients (-1.4 vs -0.5 in PD group, P=0.07; -0.8 vs +0.06 P=0.05 in DP group). Delta CPRs obtained by glucagon test were significantly decreased postoperatively (3.0 to 1.1 ng/mL, P&lt;0.0001 in PD group; 3.3 to 1.8 ng/mL, P&lt;0.0001 in DP group). In survival analysis, fasting plasma glucose &gt;110 mg/dL (HR 3.9, 95%CI 1.5-10, P=0.005) and the average of plasma insulin &gt; 25 µIU/mL during OGTT (HR 0.36, 95%CI 0.14-0.93, P=0.035) were significant prognostic factor for PDAC. Conclusions: Pancreatectomy impaired insulin secretion and improve insulin resistance especially in PDAC patients. About half of PDAC patients demonstrated the improvement of glucose tolerance after surgery. Of note, glucose tolerance differed between PDAC and other disease, and affect the survival outcome for PDAC patients.

Distal gastric mucosa ablation induces significant weight loss and improved glycemic control in type 2 diabetes Sprague-Dawley rat model.

Excluding the foregut (distal stomach and duodenum) from food transit in RYGB normalizes glucose tolerance. Excluding/removing the duodenal mucosa partly improves glycemic control. So far, the effect of excluding/removing the gastric mucosa remains unknown. To observe the effect of removing the distal gastric mucosa on glucose tolerance. Thirty fatty Sprague-Dawley rats received low-dose streptozotocin (STZ) to induce type 2 diabetes (T2D), then randomly assigned to Roux-en-Y gastric bypass (RYGB, n = 8), distal gastric mucosa removal (DGMR, n = 8), duodenal-jejunal bypass (DJB, n = 8), and Sham (n = 6) groups. In the DGMR group, the distal third of the gastric mucosa was removed by thermal ablation using an electrocautery. Rats were followed for 8 weeks postoperatively. Preoperative oral glucose tolerance test (OGTT), insulin tolerance test (ITT), and mixed-meal tolerance test (MMTT) were repeated 3 and 6 weeks postoperatively. Changes in body weight, food intake, and fasting blood glucose were also recorded. Gastrin AUC decreased significantly (p < 0.05) in the DGMR group after surgery. A significantly increased GLP-1 AUC was found in the RYGB, DGMR, and DJB groups at week 3 and only the RYGB group at week 6 postoperatively. The improved glucose tolerance in the RYGB group was significantly greater than the improved glucose tolerance in the DGMR and DJB groups. The improved glucose tolerance 3 and 6weeks after surgery in the DGMR group was significantly greater than the improved glucose tolerance in the DJB group. Body weight decreased significantly in the RYGB, DGMR, and DJB groups postoperatively. Removing the distal gastric mucosa induced significant weight loss and improved glycemic control in T2D SD rat model. Therefore, the gastric mucosa exclusion in RYGB may be key to the weight loss and diabetes remission, which perhaps warrants a new theory.

Incidence and predictive factors of hypoglycemia after pheochromocytoma resection.

To determine the incidence and preoperative risk factors of post-excisional hypoglycemia in patients undergoing pheochromocytoma resection. Patients who underwent surgical resection of pheochromocytoma at a single institution were retrospectively enrolled in the present study. The primary end-point was the development of post-excisional hypoglycemia; that is, a serum glucose level <70mg/dL. The serum levels of immunoreactive insulin and glucose levels during the preoperative oral glucose-tolerance test and surgery were analyzed to elucidate the mechanism of hypoglycemia. A total of 49 patients underwent surgical resection of pheochromocytoma, of which 21 patients (43%) developed post-excisional hypoglycemia. The incidence of hypoglycemia was not statistically different between patients with adrenal tumors and those with extra-adrenal tumors (18/41 [44%] vs 3/8 [38%], respectively, P=0.73). There was no difference in the immunoreactive insulin/glucose ratio during the preoperative oral glucose-tolerance test between patients with and those without post-excisional hypoglycemia. The intraoperative immunoreactive insulin/glucose ratio was significantly higher in patients with hypoglycemia than in those without hypoglycemia. A higher 24-h urinary epinephrine level, but not norepinephrine level, was a predictive factor for post-excisional hypoglycemia. Post-excisional hypoglycemia is a frequent complication of pheochromocytoma resection, irrespective of the tumor location, and might be common in patients with epinephrine-predominant tumors. All patients undergoing resection of adrenal and extra-adrenal pheochromocytoma require intensive monitoring of serum glucose levels during and after surgery.

New-Onset Diabetes Mellitus and the Analysis of Dipeptidyl-Peptidase-4 After Liver Transplantation

BackgroundNew-onset diabetes mellitus after transplantation (NODAT) is a common complication after orthotopic liver transplantation (OLT). The diabetogenic effect of hepatitis C virus (HCV) infection is well known. The aim of this study was to analyze the glucose homeostasis before and after OLT. The oral glucose tolerance test (OGTT) was carried out, and dipeptidyl-peptidase-4 (DPP-4) activity was measured. MethodsThe study period was from 2012 to 2014. We enrolled 49 non-diabetic patients from the waiting list (group A) and 21 patients after OLT (group B). Seven patients were monitored continuously both before and after OLT. According to our preoperative OGTT results, 13 patients in group A had newly diagnosed diabetes mellitus (group A/DM) and 11 had impaired glucose tolerance (group A/IGT). In 25 cases, normal glucose tolerance was diagnosed (group A/NGT). The calculated homeostasis model assessment insulin resistance (HOMA2-IR) values were both in group A/DM and-IGT higher compared with group A/NGT (2.42 ± 0.81 vs 2 ± 0.98 vs 1.28 ± 0.67; P = .001). In the case of HCV infection (n = 14; 29%) DM and IGT were more frequent. ResultsSix patients in group B had NODAT. In 9 cases, IGT and in 6 cases NGT was detected. In the case of HCV infection (n = 9; 43%), DPP-4 levels were higher compared with that in patients with all other indications for OLT (15.5 ± 5.2 vs 8.7 ± 3.5; P = .008). We evaluated the same individuals before and after OLT (n = 7), and a decrease in β-cell function was noted. ConclusionsPreoperative OGTT is an important and easy investigation to rule out glucose imbalance before OLT. The HOMA2 calculation can also be useful both in preoperative and postoperative risk assessment. In our results, DPP-4 activity is not specific for the type of glucose homeostasis imbalance, but, in HCV infection, it is higher. DPP-4 inhibitors can be effective in the therapy of NODAT, especially in HCV-infected patients.

New-onset diabetes after transplantation in tacrolimus-treated, living kidney transplantation: long-term impact and utility of the pre-transplant OGTT

BackgroundTo evaluate the role of the oral glucose tolerance test (OGTT) before transplantation and to examine the risk factors for new-onset diabetes after transplantation (NODAT) during long-term follow-up of renal transplant recipients receiving FK-based therapy.MethodsThe study evaluated 378 patients pre-transplantation using the OGTT and assigned them to one of three groups: Group 1, normal pattern; Group 2, impaired fasting glucose (IFG)/impaired glucose tolerance (IGT) pattern (IFG/IGT); and Group 3, DM pattern.ResultsAlthough the incidence of NODAT was higher in Group 3 than in groups 1 and 2, no significant difference was found between the three groups with regard to graft survival during long-term follow-up. Multivariate analysis showed that only a family history of diabetes was a significant factor determining NODAT progression.ConclusionsImpaired glucose tolerance appears to be a threshold influencing NODAT; however, it was not a significant factor in graft survival. Careful monitoring and management based on the result of the pre-transplantation OGTT appear to prevent the deterioration of impaired glucose tolerance in renal transplant recipients receiving FK-based therapy, even when a pre-operative OGTT shows impaired glycemic control.

Expression of Connexin26 in Islets of Langerhans Is Associated With Impaired Glucose Tolerance in Patients With Pancreatic Adenocarcinoma

Impairment of glucose tolerance is one of the leading clinical presentations in patients with pancreatic carcinoma. The mechanism of disturbed glucose metabolism, however, is still under debate. Using microarray technology, key mechanisms of deregulated molecular functions of cancer cell-specific mRNAs and tumor-induced mRNAs in peritumorous tissue should be identified in pancreatic ductal adenocarcinoma (PDAC) by comparison to chronic pancreatitis and normal pancreas. Forty-three mRNAs were abundant in tissue specimens of patients operated due to pancreatic carcinoma but absent or of low abundance in chronic pancreatitis and normal pancreas. One of these mRNAs encodes the gap junction protein connexin26, known as a tumor suppressor, which was 10.8- and 6.9-fold more abundant in pancreatic carcinoma than in normal pancreas and chronic pancreatitis, respectively. Quantitative RT-PCR was performed for connexin26, with mRNA being expressed 26.7- and 2.9-fold more than in normal pancreas (n = 6), in pancreatic carcinoma (n = 7), and chronic pancreatitis (n = 8), respectively. By immunohistochemistry, connexin26 was predominantly localized to the islets in the vicinity of the pancreatic carcinoma tissue. Control sections of tissue with chronic pancreatitis and normal pancreas show connexin26 expression in the islets as well. Interestingly, the level of mRNA abundance (fold over normal pancreas) in RT-PCR correlates (r = 0.62) with the 2h value of the pre-operative oral glucose tolerance test of these patients. Whether overexpressed connexin26 in pancreatic cancer is a cause of impaired glucose tolerance remains to be elucidated in further experimental studies.

Biliopancreatic diversion preserving the stomach and pylorus in the treatment of hypercholesterolemia and diabetes type II: results in the first 10 cases.

Besides weight loss Scopinaro's operation produces correction of hypercholesterolemia and noninsulin dependent diabetes mellitus in all patients who suffer from these conditions. These results encouraged us to perform biliopancreatic diversion (BPD) without gastric resection, thus preserving the functions of the stomach and pylorus in moderately overweight patients with hypercholesterolemia associated with diabetes type II and hypertriglyceridemia. Between March 1996 and July 1997 we performed BPD without gastric resection on 10 moderately overweight patients [mean body mass index (BMI) = 33.2 kg/m2]. All patients had suffered from hypercholesterolemia and hypertriglyceridemia for more than 5 years. Ten patients suffered from diabetes type 11; four of them had had insulin treatment or oral anti-diabetic agents; the other patients all had hyperglycaemia in the fasted state and diabetes confirmed by preoperative oral glucose tolerance test (OGTT). Five patients suffered from hypertension. In all patients, cholesterol and triglyceride levels returned to normal within the first postoperative month. Glycemia also stabilized at normal values in nine patients within the early weeks after surgery. One patient who took 70 U of insulin reduced his daily intake to 35 U 2 months postoperatively. In all patients blood pressure returned to normal. Weight loss was predictably slight (10-15 kg). Our experience with the procedure found that this new method seems to be as effective in controlling lipidic metabolism and diabetes II as the original version of BPD. As expected, weight loss is only moderate, so that the modified BPD is not suitable for very obese patients.

EFFECT OF POSTOPERATIVE TOTAL PARENTERAL NUTRITION WITH FAT EMULSION IN THE PATIENTS WITH ESOPHAGEAL VARICES ACCOMPANIED WITH GLUCOSE INTOLERANCE

The effect of total parenteral nutrition (TPN) with fat emulsion was evaluated in 20 patients with liver disorders who showed Diabetes Mellitus (DM) type in preoperative oral glucose tolerance test (OGTT). The patients were divided into two groups according to Child's classification (Child A group; 10 cases, Child B group; 10 cases) and they underwent TPN after direct operation for esophageal varices. Blood glucose level in Child B group in the first to third days after operation was over 190 mg/dl and it was higher than that of Child A group during TPN. But blood glucose level of fat containing TPN cases in both groups tended to be lower than that of fat free TPN cases. There was no abnormal finding in liver function tests during TPN with or without fat emulsion after operation. It was indicated that fat containing TPN had little influences on the liver function in patients with liver disorders such as Child A and B who were classified in DM type in preoperative OGTT. Serum essential fatty acids level before operation was lower than normal level, and it further decreased after operation. The decrease was inhibited in patients of both groups undergoing TPN with fat emulsion. The plasma removal rates of fat emulsion (K2 values) during postoperative TPN were higher than those in preoperative period.It is concluded that the administration of fat emulsion is available to the patients with liver disorder accompanied with DM in OGTT during postoperative TPN.

Lipid Metabolism in Acromegalic Patients before and after Selective Pituitary Adenomectomy.

Lipid metabolism was studied in 16 acromegalic patients who all underwent transsphenoidal selective pituitary adenomectomy (SPA). Before the operation, their serum lipid levels correlated with none of the basal levels of serum growth hormone (GH), basal levels of plasma somatomedin-C (SM-C), fasting levels of plasma glucose (FPG), peak levels of plasma glucose (PGp) or basal and peak levels of serum immunoreactive insulin (IRIb and IRIp, resp.) in the oral glucose tolerance test (OGTT), and obesity indices. The serum GH levels as well as plasma SM-C levels in the group with decreased serum high density lipoprotein-cholesterol (HDL-C) differed greatly from those of the normal HDL-C group. However, there was no significant difference in either serum GH or plasma SM-C between groups with and without metabolic abnormality of any other lipid examined. After the operation, the basal levels of serum GH and plasma SM-C decreased significantly. In conjunction with these changes, PGp, serum IRIb, serum triglyceride (TG), non-esterified fatty acid (NEFA) and very low density lipoprotein (VLDL) decreased significantly. In contrast, serum HDL-C increased significantly. However, FPG, serum IRIp, obesity indices, serum total cholesterol (TC) and serum low density lipoprotein (LDL) showed no significant change. There were no significant differences in the levels of any serum lipid either before or after surgery among the diabetic, borderline and normal types defined by the preoperative OGTT patterns. Atherogenic indices (AIs) decreased significantly and returned to normal postoperatively. These results suggest that obesity or secondary diabetes is not a direct cause of hyperlipidemia in acromegaly. The prognosis of acromegaly is affected by arteriosclerotic complications. It is intriguing, therefore, that AIs were normalized by transsphenoidal SPA. Being rather a safe procedure, it can be performed without hesitation, aside from a conservative treatment.

Insulin-Dependent Diabetes Mellitus

A euglycemic woman with acromegaly contracted conspicuous hyperglycemia two hours following transphenoidal hypophysectomy. Insulin therapy was initiated and has by necessity been continued. The development in the immediate postoperative period of blood glucose levels ranging from 300 to 500 mg/dl was totally unexpected, as the levels on the preoperative oral glucose tolerance test were normal. No explanation for this sudden development of hyperglycemia is apparent. Therefore, frequent monitoring of the blood glucose level is necessary in all acromegalic patients following hypophysectomy, even if they are euglycemic prior to surgery.