Bone metabolism and body composition in Japanese patients with active acromegaly

Kaji, Hiroshi; Sugimoto, Toshitsugu; Nakaoka, Daiki; Okimura, Yasuhiko; Kaji, Hidesuke; Abe, Hiromi; Chihara, Kazuo

doi:10.1046/j.1365-2265.2001.01280.x

Cited by 70 publications

(47 citation statements)

References 46 publications

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“…Some studies thus report significantly lower BMD at the lumbar spine in hypogonadal patients with active acromegaly than in eugonadal patients or controls (3, 15 -19, 33). Other studies report no difference in BMD at the lumbar spine between eugonadal and hypogonadal patients with active acromegaly (16,17,21). The lack of correlation between gonadal status and BMD in our cohort could be explained by the overall limited duration of untreated hypogonadism.…”

Section: Discussioncontrasting

confidence: 48%

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Long-term maintenance of the anabolic effects of GH on the skeleton in successfully treated patients with acromegaly

et al. 2005

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Introduction: The anabolic actions of growth hormone (GH) are well documented. In acromegaly, the skeletal effects of chronic GH excess have been mainly addressed by evaluating bone mineral density (BMD). Most data were obtained in patients with active acromegaly, and apparently high or normal BMD was observed in the absence of hypogonadism. Data on BMD are not available after successful treatment of acromegaly. Whether the positive effect of GH excess on bone mass is maintained in the long term after clinical and biochemical cure of acromegaly remains to be established. Patients and methods:In a cross-sectional study design, lumbar spine and femoral neck BMD was measured in 79 acromegalic patients cured or well controlled on octreotide treatment (45 male and 34 female patients; mean age 57^1 years). Successful treatment (by surgery, radiotherapy and/or use of octreotide) was defined as normal age-adjusted IGF-I. Mean time after biochemical remission was 10.2^7 years. Results: Normal or increased BMD was observed at the femoral neck and lumbar spine in both men and women in remission after treatment for acromegaly. Similar results were obtained in patients in remission for 5 years or longer. Osteoporosis was present in 15% of the patients, with similar prevalence in men and women. There was no relationship between BMD and duration or severity of GH excess before treatment, gonadal status and presence of pituitary hormone deficiencies. Pituitary irradiation was a strong negative predictor of bone mass at the femoral neck. Long-term bone loss was observed only at the femoral neck. Conclusion: Our data suggest that the anabolic effect of GH on trabecular and cortical bone remains demonstrable after remission of acromegaly, although it may not be maintained at cortical sites in the long term. In the present study, the lack of effect of gonadal status on BMD may be explained by the presence of only mild hypogonadism and by our policy of prompt hormonal replacement therapy for severe hypogonadism. The negative effect of pituitary irradiation on femoral neck BMD remains intriguing, although it is probably related to some degree of the diminished GH secretion frequently observed after this form of treatment.

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Section: Discussioncontrasting

confidence: 48%

“…Increased BMD has also been reported at the radius (19,20). Only a few studies report increased BMD at the lumbar spine (15,16,18), most studies describing normal BMD measurements at this site (3, 4, 14, 16 -18, 21). A decrease in BMD has not been reported at any site measured in active acromegaly.…”

Section: Discussionmentioning

confidence: 99%

Long-term maintenance of the anabolic effects of GH on the skeleton in successfully treated patients with acromegaly

et al. 2005

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“…GH has anabolic bone effects so bone mass is usually increased compared to normal subjects (Kaji et al 2001), unless untreated hypogonadism is also present. However, a recent meta-analysis of the literature revealed a high risk of vertebral fractures in active ACM suggesting a possible low quality of the bone despite a high bone mass (Mazziotti et al 2015).…”

Section: Complicationsmentioning

confidence: 99%

60 YEARS OF NEUROENDOCRINOLOGY: Acromegaly

Căpățînă¹,

Wass²

2015

Journal of Endocrinology

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Acromegaly (ACM) is a chronic, progressive disorder caused by the persistent hypersecretion of GH, in the vast majority of cases secreted by a pituitary adenoma. The consequent increase in IGF1 (a GH-induced liver protein) is responsible for most clinical features and for the systemic complications associated with increased mortality. The clinical diagnosis, based on symptoms related to GH excess or the presence of a pituitary mass, is often delayed many years because of the slow progression of the disease. Initial testing relies on measuring the serum IGF1 concentration. The oral glucose tolerance test with concomitant GH measurement is the gold-standard diagnostic test. The therapeutic options for ACM are surgery, medical treatment, and radiotherapy (RT). The outcome of surgery is very good for microadenomas (80-90% cure rate), but at least half of the macroadenomas (most frequently encountered in ACM patients) are not cured surgically. Somatostatin analogs are mainly indicated after surgical failure. Currently their routine use as primary therapy is not recommended. Dopamine agonists are useful in a minority of cases. Pegvisomant is indicated for patients refractory to surgery and other medical treatments. RT is employed sparingly, in cases of persistent disease activity despite other treatments, due to its long-term side effects. With complex, combined treatment, at least three-quarters of the cases are controlled according to current criteria. With proper control of the disease, the specific complications are partially improved and the mortality rate is close to that of the background population.

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“…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%

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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Bone metabolism and body composition in Japanese patients with active acromegaly

Cited by 70 publications

References 46 publications

Long-term maintenance of the anabolic effects of GH on the skeleton in successfully treated patients with acromegaly

Long-term maintenance of the anabolic effects of GH on the skeleton in successfully treated patients with acromegaly

60 YEARS OF NEUROENDOCRINOLOGY: Acromegaly

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

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