Evaluation of blood neutrophil to lymphocyte and platelet to lymphocyte ratios according to plasma glucose status and serum insulin-like growth factor 1 levels in patients with acromegaly

Abstract

<jats:sec><jats:title>Introduction:</jats:title><jats:p> Cardiovascular, respiratory, and cerebrovascular diseases and malignancies are responsible for morbidity and mortality in acromegaly. Also these diseases are associated with chronic inflammation. The neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are currently gaining interest as new markers of inflammation. Moreover, increased morbidity and mortality are positively correlated with the presence of diabetes and levels of insulin-like growth factor 1 (IGF-1) in acromegaly. The objective of the present study was to investigate the relationship between these markers and acromegaly according to plasma glucose status and serum IGF-1 levels. </jats:p></jats:sec><jats:sec><jats:title>Materials and Methods:</jats:title><jats:p> We retrospectively analyzed data from 61 acromegaly patients who were in a newly diagnosed period (35 male, 26 female; mean age 38.13 ± 13.98). Patients with normal plasma glucose ( n = 27), impaired fasting glucose ( n = 18), and diabetes mellitus ( n = 16) were categorized into three different groups. NLR and PLR were compared between the study groups and were evaluated according to IGF-1 levels. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> There were no statistically significant differences in NLR and PLR measurements among the study groups ( p &gt; 0.05). However, there were significant positive correlations between NLR and IGF-1 levels and between PLR and IGF-1 levels when all patients were evaluated ( r = 0.334, p = 0.011 and r = 0.277, p = 0.035, respectively). </jats:p></jats:sec><jats:sec><jats:title>Conclusions:</jats:title><jats:p> This is the first report studying the relationship of NLR and PLR with glucose status and IGF-1 levels in acromegaly patients. Our study results suggest that subclinical inflammation may play a role in increased incidence of mortality and morbidity, which depends on uncontrolled IGF-1 levels in patients with acromegaly. </jats:p></jats:sec>

Acromegaly, inflammation and cardiovascular disease: a review

“…It is likely that GH and IGF-1 excess has a negative impact on the CV and immune system, which may contribute to the pathogenesis of CVD in patients with acromegaly. However, studies on the role of the immune system in the development of CVD in acromegaly are scarce, and both increased as well as unaltered inflammatory and cardiovascular markers have been reported [21,22,134,136].…”

“…Indeed, in patients with risk factors for atherosclerosis or with established atherosclerosis, circulating monocytes have a pro-inflammatory phenotype, characterized by an increased cytokine production capacity [ 19 , 131 – 133 ]. It is suggested that this concept may also apply to acromegaly [ 118 , 134 – 137 ], since GH and IGF-1 have repeatedly been reported to impact on the immune system [ 20 , 138 , 139 ]. Moreover, circulating immune cells express GH and IGF-1 receptors [ 138 , 140 , 141 ], and macrophages and lymphocytes can produce IGF-1 [ 20 , 142 , 143 ].…”

Persistent inflammation and endothelial dysfunction in patients with treated acromegaly

“…Moreover, exposure to IGF1 induces trained immunity (19). However, studies on the inflammatory profile of acromegaly patients rendered conflicting results: both unaltered as well as pro-inflammatory phenotypes have been reported (20, 21, 22). On the other hand, previous studies on the risk of CVD in (treated) acromegaly imply that the arterial structure and function of patients with acromegaly is impaired, which might contribute to the development of CVD (6).…”

Co-Occurrence of Acromegaly and Hematological Disorders: A Myth or Common Pathogenic Mechanism

“…The neutrophil to lymphocyte ratio and platelet to lymphocyte ratio are good markers for inflammation. In their study, Üçler et al [6] demonstrated that there exists a significant positive correlation between the neutrophil to lymphocyte ratio and IGF-1 levels ( p = 0.011) as well as between the platelet to lymphocyte ratio and IGF-1 ( p = 0.035). Acromegaly patients show significant fibrinogen and antithrombin activity, thereby showing an increased tendency to coagulation and enhanced platelet aggregability [7] .…”