Abnormalities of carbohydrate metabolism in acromegaly

作者：Biagetti Betina^*; Obiols Gabriel; Valladares Silvia; Arnez Lorena; Dalama Belen; Mesa Jordi

来源：Medicina Clinica, 2013, 141(10): 442-446.

DOI：10.1016/j.medcli.2013.05.035

• Acromegaly
• Complications
• Epidemiology
• Diabetes
• Somatostatin analogues
• Pegvisomant

Background and objective: Carbohydrate metabolism (CHM) is impaired in over 50% of acromegalic patients. Natural history of acromegaly and treatment modalities may impact in a different way on CHM. We assessed CHM alterations in acromegaly and their relationship with clinical features and treatment options. %26lt;br%26gt;Patients and method: Retrospective study with 55 patients with acromegaly. Age, sex, body mass index (BMI), tumor size, insulin growth factor type 1 (IGF-1) levels and the presence of impaired fasting glucose (IFG) or diabetes mellitus (DM) were analyzed before and after surgery or medical treatment. %26lt;br%26gt;Results: There were 30 men and 25 women. Mean age was 50 +/- 17 years and mean BMI was 27.9 +/- 3.8 Kg/m(2). Impaired CHM was found in 50.9% (n = 28) (DM in 27% and IFG in 24%). In diabetic patients, we found no differences in age, sex, BMI and IGF-1 levels between IFG/DM and patients without CHM impairment. However, IFG/DM patients had macroadenomas more commonly. In diabetic patients, glycosylated hemoglobin (HbA(1c)) decreased after surgery from 7.6 to 6.7% and after somatostatin analogues from 7.1 to 6.6%; in patients on pegvisomant we observed a significant reduction of HbA(1c): from 9.8 to 5.6% (P %26lt; .005). Furthermore, only in the pegvisomant group, insulin and/or oral agents had to be lowered. %26lt;br%26gt;Conclusions: Up to 50% of patients with active acromegaly have CHM impairment which correlates with tumor size. Only pegvisomant is associated with significant improvement in glycemic control and a reduction in hypoglycemic treatment.

• 出版日期2013-11-16