Increased Risk of Persistent Glucose Disorders After Control of Acromegaly

Rochette, C.; Graillon, Thomas; Albarel, F.; Morange, Isabelle; Dufour, Henry; Brue, Thierry

doi:10.1210/js.2017-00334

Cited by 15 publications

(11 citation statements)

References 30 publications

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“…As previously mentioned, a highly significant increase in glucose level (p<0.001) was found in the standard treatment group but there was no significant change in insulin level (p>0.05) nor HOMA score. The cause of hyperglycaemia noted in this study is probably a combined effect of increased weight gain [32] , altered B-cell action at The time of acromegaly diagnosis, family history of diabetes [33] , octreotide therapy [34] the deleterious effect of sleep apnea itself [35] [36] . melatonin transmembrane receptors (MT1, MT2), (the chief isoforms responsible for melatonin action) were found to be expressed in islets of Langerhans, and engaged in the harmonization of insulin, glucagon secretion from β-cells and α-cells respectively.…”

Section: Outcome Of Melatonin Addition On Serum Insulin Capillary Blmentioning

confidence: 69%

Outcome Melatonin Supplementation on Insulin Resistance in a Sample of Iraqi Acromegalic Patients with Sleep Apnea

2019

AJPS

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Sleep apnea, a common respiratory complication of acromegaly is accountable for 25% of deaths in acromegalic patients. It contributes to increasing cardiovascular diseases and raising mortality rate in acromegalic patients and still persists after control of acromegaly. Raised insulin resistance that was noticed in some acromegalic patients are believed to be caused by acromegaly itself, weight gain, octreotide therapy or the deleterious effect of sleep apnea itself. It was found that both acromegaly and sleep apnea share a disordered melatonin secretion. Numerous clinical and experimental studies have shown a promising role of melatonin as an antidiabetic agent. Nevertheless, no other study had examined the effect of melatonin supplementation on insulin resistance level in acromegalic patients receiving their standard treatment and experiencing some sleep difficulties. The study was designed to scrutinize the effect of melatonin supplementation on insulin resistance in controlled acromegalic patients who had been receiving their standard treatment. It was a prospective randomised controlled open labelled study included 27 Iraqi acromegalic patients. Their age ranged (29-57).The patients were receiving their usual octreotide monthly dose determined by the physician to control their disease and they had moderate to severe sleep apnea (Epworth sleepiness scale and STOP-BANG score were used to include them in the study ,they were enrolled if the summation of their ESS points ≥10 or of their STOP-BANG points ≥3).The patients were divided into two groups, group 1 included 15 patients taking their usual octreotide dose once monthly plus 5 mg of melatonin at night, group 2 included 12 patients taking their usual octreotide dose only. Blood samples were taken at fasting state at baseline and after 2 months to estimate serum growth hormone (GH), insulin like growth factor-1 (IGF-1), insulin and blood glucose. The homeostatic model assessment for insulin resistance (HOMA) result was calculated for each subject. At the end of the study period, melatonin treated group showed no significant change in GH, IGF-1, a highly significant decrease in glucose level (p<0.001), a highly significant decrease in insulin (p<0.001) and a highly significant decrease in HOMA score (p<0.001).Standard treatment group showed no significant difference in GH, IGF-1, insulin level and HOMA score at the end of the two months study period and a highly significant increase in glucose level. In conclusion, our study has confirmed the existing evidence of that melatonin supplementation improves glucose homeostasis and offers promising tool for future studies in acromegalic patients and larger trials.

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Section: Outcome Of Melatonin Addition On Serum Insulin Capillary Blmentioning

confidence: 69%

Outcome Melatonin Supplementation on Insulin Resistance in a Sample of Iraqi Acromegalic Patients with Sleep Apnea

2019

AJPS

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“…Diabetes mellitus is a frequent complication of acromegaly with a prevalence of 12-37 percent (2) . Insulin resistance, hyperinsulinemia, and increased gluconeogenesis in combination create a favorable environment for the development of type 2 diabetes in acromegaly (3) .…”

Section: Discussionmentioning

confidence: 99%

Is There Any Other Disease Under The New Diagnosis of Diabetes That Is Difficult To Control?

Kaypak¹,

Patıe²,

Özalp³

et al. 2021

Terh

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High levels of growth hormone and insulin-like growth factor 1 contribute to tissue proliferation and hypertrophy in patients with acromegaly mostly due to growth hormone-secreting pituitary adenoma. Some phenotypic features of acromegaly that make us to consider in the differential diagnosis are excessive growth of the hands and feet and coarsening facial features. Growth hormone also induces lipolytic activities and insulin resistance, so patients with acromegaly often present with impaired glucose tolerance and type 2 diabetes mellitus. We wanted to share a case with treatment-resistant hyperglycemia which is the cause of presentation of acromegaly.

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“…Despite the control of GH hypersecretion significantly improves the metabolic complications of acromegaly, DM maintains a higher prevalence in acromegaly patients in remission compared to general population, therefore the follow-up of glucose disorders needs to be performed on a long-term basis also in patients with controlled disease ( 100 ).…”

Section: Glucose Metabolism Alterations and Hypopituitarismmentioning

confidence: 99%

Diabetes Secondary to Acromegaly: Physiopathology, Clinical Features and Effects of Treatment

et al. 2018

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Acromegaly is a rare disease due to chronic GH excess and to the consequent increase in IGF-1 levels. Both GH and IGF-1 play a role in intermediate metabolism affecting glucose homeostasis. Indeed, chronic GH excess impairs insulin sensitivity, increases gluconeogenesis, reduces the glucose uptake in adipose tissue and muscle and alters pancreatic β cells function. As a consequence, glucose metabolism alterations are a very frequent complication in acromegaly patients, further contributing to the increased cardiovascular risk and mortality. Treatment modalities of acromegaly differently impact on glucose tolerance. Successful surgical treatment of acromegaly ameliorates glucose metabolism abnormalities. Drugs used to treat acromegaly patients may per se affect glucose homeostasis, therefore influencing patients' management. Indeed pegvisomant has been shown to positively impact on glucose metabolism, while somatostatin analogs, especially pasireotide, can cause hyperglycaemia. On the other hand, robust data on the effect of dopamine agonists on glycaemic profile are still lacking. This review summarizes the available data on diabetes mellitus in acromegaly patients, with a focus on the potential effects of the medical treatment of the disease on glucose homeostasis, providing an overview of the current state of the art.

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Increased Risk of Persistent Glucose Disorders After Control of Acromegaly

Cited by 15 publications

References 30 publications

Outcome Melatonin Supplementation on Insulin Resistance in a Sample of Iraqi Acromegalic Patients with Sleep Apnea

Outcome Melatonin Supplementation on Insulin Resistance in a Sample of Iraqi Acromegalic Patients with Sleep Apnea

Is There Any Other Disease Under The New Diagnosis of Diabetes That Is Difficult To Control?

Diabetes Secondary to Acromegaly: Physiopathology, Clinical Features and Effects of Treatment

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