Body composition in active acromegaly during treatment with octreotide: a double‐blind, placebo‐controlled cross‐over study

Hansen, Torben Bæk; Gram, Jeppe; Bjerre, Per; Hagen, Claus; Bollerslev, Jens

doi:10.1111/j.1365-2265.1994.tb02552.x

Cited by 30 publications

(17 citation statements)

References 19 publications

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“…46 Furthermore, if another mechanism other than insulin suppression was responsible for the weight loss, subjects receiving octreotide for acromegaly or other disorders would be expected to lose weight and fat mass; indeed long-term octreotide usage has minimal effects on these parameters. 47 We found that insulin suppression for 24 weeks was associated with marked weight loss (mean 12.6 kg) in 18% of an otherwise healthy subpopulation of adult obese subjects, and a small but significant weight loss (mean 3.6 kg) in another 57%. This weight loss occurred without dietary or exercise intervention, and occurred slowly but without asymptote.…”

Section: Discussionmentioning

confidence: 97%

Suppression of insulin secretion is associated with weight loss and altered macronutrient intake and preference in a subset of obese adults

et al. 2003

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PURPOSE:Hyperinsulinemia is a common feature of many obesity syndromes. We investigated whether suppression of insulin secretion, without dietary or exercise intervention, could promote weight loss and alter food intake and preference in obese adults. METHODS: Suppression of insulin secretion was achieved using octreotide-LAR 40 mg IM q28d for 24 weeks in 44 severely obese adults (89% female, 39% minority). Oral glucose tolerance testing was performed before and after treatment, indices of b-cell activity (CIRgp), insulin sensitivity (CISI), and clearance (CP/I AUC) were computed, and leptin levels, 3-day food records and carbohydrate-craving measurements were obtained. DEXA evaluations were performed pre-and post-therapy in an evaluable subgroup. RESULTS: For the entire cohort, significant insulin suppression was achieved with simultaneous improvements in insulin sensitivity, weight loss, and body mass index (BMI). Leptin, fat mass, total caloric intake, and carbohydrate craving significantly decreased. When grouped by BMI response, high responders (HR; DBMIoÀ3 kg/m 2 ) and low responders (LR; DBMI between À3 and À0.5) exhibited higher suppression of CIRgp and IAUC than nonresponders (NR; DBMI > À0.5). CISI improved and significant declines in leptin and fat mass occurred only in HR and LR. Conversely, both leptin and fat mass increased in NR. Carbohydrate intake was markedly suppressed in HR only, while carbohydrate-craving scores decreased in HR and LR. For the entire cohort, DBMI correlated with DCISI, Dfat mass, and Dleptin. DFat mass also correlated with DIAUC and DCISI. CONCLUSIONS: In a subcohort of obese adults, suppression of insulin secretion was associated with loss of body weight and fat mass and with concomitant modulation of caloric intake and macronutrient preference.

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Section: Discussionmentioning

confidence: 97%

Suppression of insulin secretion is associated with weight loss and altered macronutrient intake and preference in a subset of obese adults

et al. 2003

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“…In most studies, an increase in LBM is found in active acromegaly, but again no gender differences have been reported (1,6,7,9,31). GH hypersecretion has clear anabolic effects on protein synthesis in acromegaly.…”

Section: Discussionmentioning

confidence: 99%

“…It is known that GH excess causes marked expansion of extracellular fluid volume, reduction in body FM, and increases LBM and BMD (6)(7)(8)(9)(16)(17)(18)(19)(20). In both genders, when serum GH and IGF1 decrease after treatment, body weight falls over the first weeks due to a decrease in total body water, body cell mass, and LBM (3,4,6,16). But in most of the studies, body weight returned to previous ranges, due to an increase in body FM, 3 months after hormonal normalization (3,4,14,16,18).…”

Section: Discussionmentioning

confidence: 99%

“…Dual-energy X-ray absorptiometry (DEXA), introduced more recently in the assessment of BC, has the advantage of providing a comprehensive, non-invasive estimate of each tissue compartment. BC changes in acromegaly, namely body weight, lean body mass (LBM), and bone mineral content (BMC) increase, while fat mass (FM) is reduced (3,(6)(7)(8)(9), but differences between genders have not been previously described. Increased body fat, and especially visceral fat, is associated with an increase in cardiovascular risk in normal population (10,11) and different diseases (11)(12)(13); whether a decrease in body fat is related to changes in cardiovascular risk in acromegaly is not known.…”

Section: Introductionmentioning

confidence: 99%

“…At the time of the study, three persons were awaiting transsphenoidal surgery and were on somatostatin analog treatment. As secondary treatment, 6 were reoperated (transsphenoidally) and 22 were irradiated (19 with conventional and 3 with stereotactic radiosurgery). At study entry, GH hypersecretion persisted in 19 patients, of which 17 were treated with somatostatin analogs and 3 with pegvisomant.…”

Section: Introductionmentioning

confidence: 99%

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Gender dimorphism in body composition abnormalities in acromegaly: males are more affected than females

Sucunza

Barahona²,

Resmini³

et al. 2008

European Journal of Endocrinology

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Background: Acromegaly changes body composition (BC), but long-term gender differences have not been reported. Objective: To evaluate BC in active and controlled acromegalic patients. Design and methods: Clinical and biochemical variables and BC (by dual-energy X-ray absorptiometry) were evaluated in 60 acromegalic patients (19 active, 41 controlled) and 105 controls, matched for age and gender. Results: Acromegalic males (nZ24) had more total mass (89G13 vs 76.5G15.3 kg, P!0.001), lean body mass (LBM; 64.6G8.7 vs 56.4G5.8 kg, P!0.001), and bone mineral content (BMC; 2.9G0.5 vs 2.6G0.3 kg, P!0.05) than controls (nZ33). Controlled male patients (nZ14) had more total mass (89G14.7 vs 76.5G15.3 kg, P!0.05) and a trend to have more LBM (61.8G9.4 vs 56.4G5.8 kg, PZ0.065) than controls. Only in active disease was a decrease in fat mass (FM) observed, compared with controlled patients and controls (males: 19.5G5.3 vs 27G6.2 and 25.9G4%, P!0.001; females: 30.3G 6.7 vs 37.1G5.8 and 36.5G6.6%, P!0.01). In females, no further differences were observed. No differences in BMC were found between eugonadal and hypogonadal acromegalic patients, but in hypogonadal females, acromegaly appeared to prevent the BMC loss seen in hypogonadal postmenopausal controls. GH and IGF1 levels were negatively correlated with FM (males, P!0.05; females, P!0.001), but in the regression analysis GH was a predictor of FM only in women. Conclusions: Control of acromegaly reverts decreased FM in both genders; only in males more total mass and a trend for more LBM persist. The anabolic effect of GH on bone reverted in cured males, but persisted in females and appeared to override the bone loss of menopause.

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Effect of 4 weeks of octreotide treatment on prolactin, thyroid stimulating hormone and thyroid hormones in acromegalic patients. A double blind placebo-controlled cross-over study

Andersen

Hansen

Bollerslev

et al. 1995

J Endocrinol Invest

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We aimed to test the hypothesis, that octreotide has a suppressive effect on unstimulated and TRH-stimulated PRL levels in both normo- and hyperprolactinaemic acromegalic patients, and besides to evaluate the effect of octreotide on unstimulated TSH and thyroid hormones. The present study is a doubleblind placebo-controlled cross-over trial; the 12 acromegalic patients were treated with octreotide or placebo (300 micrograms/d) for 4 weeks separated by a 12 weeks washout period. Before and after each 4 weeks period a TRH-test (200 micrograms iv) was performed and serum GH and PRL levels were determined. Serum TSH and thyroid hormones were determined after 0, 2, 3, and 4 weeks. In the whole group unstimulated PRL levels were 18 micrograms/l +/- 5 before and 7 micrograms/l +/- 1 during octreotide treatment (p < 0.01). The PRL lowering effect of octreotide was significantly more pronounced in hyperprolactinemic patients compared to normoprolactinaemic patients (p < 0.05). Patients with the highest pretreatment PRL levels had the most pronounced percentage suppression of unstimulated PRL levels during octreotide treatment. Eight out of 12 patients had a TRH-stimulated PRL response > or = 100%, both during placebo and octreotide treatment, but in the group as a whole maximal TRH-stimulated PRL levels were suppressed during octreotide treatment, PRL levels were 50 micrograms/l +/- 20 before and 18 micrograms/l +/- 3 during octreotide treatment (p < 0.05). Unstimulated GH levels were 48 mU/l +/- 15 before and 13 mU/l +/- 2 during octreotide treatment (p < 0.01). Serum total T3 was significantly reduced during octreotide treatment (p < 0.05); serum TSH, total T4 or free T4 index were not significantly changed during treatment. We conclude that patients with acromegaly and hyperprolactinemia will normalize PRL levels during 4 weeks of octreotide treatment and octreotide will reduce total T3 levels in acromegalic patients.

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Body composition in active acromegaly during treatment with octreotide: a double‐blind, placebo‐controlled cross‐over study

Cited by 30 publications

References 19 publications

Suppression of insulin secretion is associated with weight loss and altered macronutrient intake and preference in a subset of obese adults

Suppression of insulin secretion is associated with weight loss and altered macronutrient intake and preference in a subset of obese adults

Gender dimorphism in body composition abnormalities in acromegaly: males are more affected than females

Effect of 4 weeks of octreotide treatment on prolactin, thyroid stimulating hormone and thyroid hormones in acromegalic patients. A double blind placebo-controlled cross-over study

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