A case of secondary diabetes mellitus with acromegaly improved by pioglitazone

Watanabe, Ayaka; Komine, Fumiko; Nirei, Kazusige; Tamura, K.; Nabe, Koichiro; Aiba, Naoko; Kamoshida, Shingo; Otsuka, Makiko; Okubo, Hirofumi; Kanou, Masanobu; Sawada, Shojiro; Uchiyama, Tsuyoshi; Nakamura, Shin; Arakawa, Yasuyuki

doi:10.1111/j.1464-5491.2004.01299.x

Cited by 7 publications

(4 citation statements)

References 8 publications

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“…Pioglitazone has also been successfully used as antidiabetic treatment in patients with acromegaly, as shown in two case reports ( 156 ). Preclinical findings showed that thiazolidinediones also reduced circulating GH and IGF-1 levels and GH pituitary cell hormone secretion ( 157 , 158 ).…”

Section: Acromegalymentioning

confidence: 99%

Practical therapeutic approach in the management of diabetes mellitus secondary to Cushing’s syndrome, acromegaly and neuroendocrine tumours

Guarnotta,

Emanuele,

Salzillo

et al. 2023

Front. Endocrinol.

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Cushing’s syndrome, acromegaly and neuroendocrine disorders are characterized by an excess of counterregulatory hormones, able to induce insulin resistance and glucose metabolism disorders at variable degrees and requiring immediate treatment, until patients are ready to undergo surgery. This review focuses on the management of diabetes mellitus in endocrine disorders related to an excess of counterregulatory hormones. Currently, the landscape of approved agents for treatment of diabetes is dynamic and is mainly patient-centred and not glycaemia-centred. In addition, personalized medicine is more and more required to provide a precise approach to the patient’s disease. For this reason, we aimed to define a practical therapeutic algorithm for management of diabetes mellitus in patients with glucagonoma, pheochromocytoma, Cushing’s syndrome and acromegaly, based on our practical experience and on the physiopathology of the specific endocrine disease taken into account. This document is addressed to all specialists who approach patients with diabetes mellitus secondary to endocrine disorders characterized by an excess of counterregulatory hormones, in order to take better care of these patients. Care and control of diabetes mellitus should be one of the primary goals in patients with an excess of counterregulatory hormones requiring immediate and aggressive treatment.

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Section: Acromegalymentioning

confidence: 99%

Practical therapeutic approach in the management of diabetes mellitus secondary to Cushing’s syndrome, acromegaly and neuroendocrine tumours

Guarnotta,

Emanuele,

Salzillo

et al. 2023

Front. Endocrinol.

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“…According to a clinical study of 70 patients with acromegaly and secondary DM, 15.7% of patients are controlled on diet, 65.7% of patients receive metformin as monotherapy or in combination with other oral anti-diabetic medications and 21.5% of patients are insulin-treated, with all exhibiting excellent glycemic control (mean HbA1c = 6.4%) and low prevalence of diabetic microangiopathy [ 138 ]. Furthermore, thiazolidinediones have been demonstrated to achieve optimal glycemic control and allow insulin discontinuation in 2 case reports [ 139 , 140 ]. Moreover, a recently-published case series in 9 patients receiving sodium-glucose-co-transporter 2 inhibitors (SGLT2is) shows 1% decrease in HbA1c without adverse events [ 141 ].…”

Section: Treatment Of Secondary and Pasi-induced Dm In Acromegalymentioning

confidence: 99%

Secondary diabetes mellitus in acromegaly

et al. 2023

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Secondary diabetes mellitus (DM) is a common complication of acromegaly, encountered in up to 55% of cases. Vice versa, the prevalence of acromegaly is markedly higher in cohorts of patients with type 2 DM (T2DM). The presence of secondary DM depends primarily on acromegaly status and is associated with increased cardiovascular morbidity, malignancy rate and overall mortality. The principal pathophysiologic mechanism is increased insulin resistance due to excessive lipolysis and altered fat distribution, reflected at the presence of intermuscular fat and attenuated, dysfunctional adipose tissue. Insulin resistance is ascribed to the direct, diabetogenic effects of growth hormone (GH), which prevail over the insulin-sensitizing effects of insulin-like growth factor 1 (IGF-1), probably due to higher glucometabolic potency of GH, IGF-1 resistance, or both. Inversely, GH and IGF-1 act synergistically in increasing insulin secretion. Hyperinsulinemia in portal vein leads to enhanced responsiveness of liver GH receptors and IGF-1 production, pointing towards a mutually amplifying loop between GH-IGF-1 axis and insulin. Secondary DM occurs upon beta cell exhaustion, principally due to gluco-lipo-toxicity. Somatostatin analogues inhibit insulin secretion; especially pasireotide (PASI) impairs glycaemic profile in up to 75% of cases, establishing a separate pathophysiologic entity, PASI-induced DM. In contrast, pegvisomant and dopamine agonizts improve insulin sensitivity. In turn, metformin, pioglitazone and sodium-glucose transporters 2 inhibitors might be disease-modifying by counteracting hyperinsulinemia or acting pleiotropically. Large, prospective cohort studies are needed to validate the above notions and define optimal DM management in acromegaly.

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“…В литературе описаны два клинических случая применения у больных с акромегалией тиазолидиндионов, назначение которых обеспечило оптимальный гликемический контроль и позволило отменить инсулинотерапию [81,82]. Гамма-рецептор, активирующий пролиферацию пероксисом (PPARγ), экспрессируется в соматотропиномах, пролактиномах и гонадотропиномах, и по данным экспериментальных исследований тиазолидиндионы ингибируют секрецию ГР и пролактина, а также рост опухолевых клеток аденогипофиза in vivo и in vitro [83].…”

Section: лечение сахарного диабета при акромегалииunclassified

Diabetes mellitus in acromegaly: prevalence, pathophysiological particulars and treatment strategies

Ilovayskaya,

Galstyan

2023

Almanac of Clinical Medicine

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The prevalence of diabetes mellitus in acromegaly is significantly higher than that in the general population. Carbohydrate metabolism abnormalities often precede other phenotypic manifestations of acromegaly. The review presents data on the prevalence of carbohydrate metabolism disorders in acromegaly and describes their pathophysiological characteristics and approaches to treatment. Growth hormone (GH) excess is recognized as a key factor of glucose homeostasis abnormalities due to decreased insulin sensitivity (resulting from active lipolysis) and direct stimulation of insulin secretion. Insulin-like growth factor 1 (IGF1) improves insulin sensitivity; however, the GH diabetogenic effects prevail over the insulin-sensitizing impact of IGF1. Surgical and radiation treatment for somatotropinoma may indirectly improve carbohydrate metabolism, because they decrease the GH levels. Treatment with first generation somatostatin analogues can both improve glycemic control due to decreased GH levels and worsen it due to deterioration of postprandial insulin release, especially in patients with already manifest carbohydrate metabolism disorders. The GH receptor antagonist pegvisomant blocks the effects of excess GH on the target tissues without suppressing insulin secretion, which results in better glucose control; treatment with this agent can be preferred in patients with acromegaly and diabetes mellitus. Management of carbohydrate metabolism disorders in acromegaly is done in accordance with general treatment principles for type 2 diabetes mellitus.

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A case of secondary diabetes mellitus with acromegaly improved by pioglitazone

Abstract: Pioglitazone treatment might be considered as a choice for similar cases of diabetes secondary to acromegaly.

Cited by 7 publications

References 8 publications

Practical therapeutic approach in the management of diabetes mellitus secondary to Cushing’s syndrome, acromegaly and neuroendocrine tumours

Practical therapeutic approach in the management of diabetes mellitus secondary to Cushing’s syndrome, acromegaly and neuroendocrine tumours

Secondary diabetes mellitus in acromegaly

Diabetes mellitus in acromegaly: prevalence, pathophysiological particulars and treatment strategies

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