Drug treatment strategies for secondary diabetes in patients with acromegaly

Störmann, Sylvère; Schopohl, Jochen

doi:10.1080/14656566.2020.1789098

Cited by 6 publications

(7 citation statements)

References 170 publications

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“…Current therapeutic management of diabetes secondary to acromegaly is based on expert opinions and general recommendations of typical T2DM ( 114 , 154 ).…”

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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“…Current therapeutic management of diabetes secondary to acromegaly is based on expert opinions and general recommendations of typical T2DM ( 114 , 154 ).…”

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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“…Pada 23,8% pasien akromegali diketahui menderita DM. 17 Secara patofisiologi DM yang terjadi pada pasien akromegali mirip dengan DM tipe 2 yaitu terjadinya resistensi insulin. Namun, ada beberapa perbedaan yang melekat antara pasien dengan akromegali dan diabetes tipe 2.…”

Section: Pembahasanunclassified

“…Sebaliknya, pasien dengan akromegali umumnya memiliki fenotip ramping dengan sedikit lemak viseral, dan resistensi insulin adalah terkait dengan kelebihan GH/IGF-1. 17,18 Growth hormone memainkan efek fisiologis pada metabolisme glukosa secara langsung, dengan menginduksi glukoneogenesis, glikogenolisis serta lipolisis dan meningkatkan resistensi insulin baik di hati dan perifer. Kondisi ini secara tidak langsung, melalui stimulasi IGF-1, memfasilitasi kerja insulin.…”

Section: Pembahasanunclassified

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Laporan Kasus: MAKROADENOMA HIPOFISIS FUNGSIONAL DENGAN MANIFESTASI AKROMEGALI DAN DIABETES MELITUS TIPE LAIN YANG TIDAK TERKONTROL

Fitricana

Ardianto

Shahab

et al. 2022

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Akromegali merupakan penyakit yang sangat jarang dan sering tidak disadari, sehingga menimbulkan keterlambatan diagnosis serta munculnya komplikasi sistemik. Peningkatan kadar growth hormone pada pasien akromegali menyebabkan munculnya penyakit diabetes mellitus (DM). Laporan kasus ini bertujuan untuk membahas makroadenoma hipofisis fungsional dengan manifestasi akromegali dan diabetes melitus tipe lain yang tidak terkontrol. Laki-laki berusia 39 tahun dirujuk ke RS Dr. Mohammad Hoesin karena DM yang tidak terkontrol, sering sakit kepala, nyeri di tangan dan kaki serta pandangan mata kabur. Pasien merasakan perubahan pada tubuh yang bertambah besar sejak tahun 2004. Pada tahun 2018 pasien mulai menderita DM dengan terapi insulin yang dosisnya meningkat bertahap. Pada pemeriksaan fisik dijumpai gambaran khas akromegali mulai dari muka serta jari tangan dan kaki. Pemeriksaan mata dengan tes Humprey didapatkan gangguan lapangan pandang pada kedua mata. Pemeriksaan penunjang didapatkan kadar insulin-like growth factor-1 (IGF-1) yang sangat tinggi dan gambaran massa di hipofisis yang berukuran 32 x 22 x 28 mm. Pasien menjalani operasi transpheonidal (TSS) dengan hasil pemeriksaan patalogi didapatkan suatu adenoma hipofisis. Pasien didiagnosis dengan akromegali oleh karena makroadenoma hipofisis fungsional dengan DM tipe lain. Lima hari setelah operasi pasien didapatkan kebocoran liquor cerebro spinal (LCS) dan kembali dilakukan operasi untuk mengatasi kebocoran LCS. Pasien menderita DI permanen setelah 2 minggu setelah operasi. Setelah TSS didapatkan ukuran tumor berkurang sekitar 54% dan pasien mendapat terapi lanjutan somatostatin analogs (SSA) octretide longacting release (LAR). Kondisi post TSS terjadi perbaikan klinis dan kadar gula darah.

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“…Chronic GH excess leads to numerous systemic sequelae, including cardiovascular disease, osteoarthropathy, metabolic complications, respiratory disease, increased risk for some neoplasms, vertebral fractures, reduced quality of life, and hypopituitarism (1). Growth hormone affects glucose tolerance by an increase in glucose concentrations and insulin resistance due to a bimodal effect on carbohydrate metabolism: On the one hand, GH stimulates beta cell proliferation and insulin synthesis and secretion; on the other hand, it counteracts insulin action and increases lipolysis (2). GH increases glycogenolysis and thus enhances hepatic glucose production (3).…”

Section: Introductionmentioning

confidence: 99%

Management of pasireotide-induced hyperglycemia in patients with acromegaly: An experts’ consensus statement

Störmann,

Meyhöfer,

Groener

et al. 2024

Front. Endocrinol.

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Pasireotide is a somatostatin analogue for the treatment of acromegaly, a chronic condition caused by excess growth hormone. Despite the therapeutic benefits of pasireotide as a second-line treatment for inadequately controlled acromegaly, a major concern is its hyperglycemic side-effect. Here, we provide guidance on how to select appropriate patients with acromegaly for treatment with pasireotide. We summarize baseline characteristics of patients at high risk for pasireotide-associated hyperglycemia and recommend a monitoring strategy based on the risk profile. Self-monitoring of blood glucose levels (SMBG), measurements of fasting plasma glucose (FPG), postprandial plasma glucose (PPG) and regular HbA1c measurements are the foundation of our proposed monitoring approach. The pathophysiology of pasireotide-induced hyperglycemia involves decreased secretion of the incretin hormones GIP (glucose-dependent insulinotropic polypeptide) and GLP-1 (glucagon-like peptide-1). Our expert recommendations address the specific pathophysiology of pasireotide-induced hyperglycemia by recommending the incretin-based therapeutics dipeptidyl peptidase-4 inhibitors (DPP-4i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) in all appropriate patients as an alternative to first-line monotherapy with metformin. Furthermore, we emphasize the importance of adequate control of acromegaly, excellent diabetes education, nutrition and lifestyle guidance and advise to consult expert diabetologists in case of uncertainty in the management of patients with hyperglycemia under pasireotide.

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Drug treatment strategies for secondary diabetes in patients with acromegaly

Cited by 6 publications

References 170 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

Laporan Kasus: MAKROADENOMA HIPOFISIS FUNGSIONAL DENGAN MANIFESTASI AKROMEGALI DAN DIABETES MELITUS TIPE LAIN YANG TIDAK TERKONTROL

Management of pasireotide-induced hyperglycemia in patients with acromegaly: An experts’ consensus statement

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