Long-Term Effect of Octreotide in Acromegaly on Insulin Resistance

Pinzer, Thomas; Wildbrett, J.; Bornstein, Stefan R.; Hanefeld, Markolf

doi:10.1055/s-2007-979945

Cited by 26 publications

(17 citation statements)

References 7 publications

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“…An improvement of insulin resistance after surgery has been already observed for 30 years (40,53,54). This seems to be an advantage over the treatment with somatostatin analogues, which may counterbalance improvement of insulin resistance by their inhibitory effect on insulin secretion (55,56). Since surgery lowered FBG and insulin resistance irrespective of the presence or absence of SAS, we speculate that reduction of GH excess rather than cure of SAS caused amelioration of glucose metabolism.…”

Section: Discussionmentioning

confidence: 66%

Effect of transsphenoidal surgery on sleep apnoea in acromegaly

Sze

Schmid²,

Bloch³

et al. 2007

eur j endocrinol

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Objective: Sleep apnoea syndrome (SAS) is common in acromegaly and both diseases are independently associated with hypertension and insulin resistance contributing to increased morbidity and mortality. Pituitary surgery remains the principal treatment modality in acromegaly. The aim of this study was to assess the prevalence and risk factors of SAS in acromegaly and to analyze the effect of transsphenoidal adenomectomy on SAS and cardiovascular risk factors. Subjects and methods: Thirteen consecutive patients (seven women and six men, aged 25-77 years) with newly diagnosed acromegaly were prospectively studied. Biochemical assessment (IGF-I, GH, acid labile subunit, fasting blood glucose (FBG), insulin), overnight respiratory polygraphy, and an Epworth Sleepiness scale score (ESS) were obtained before and 12 weeks after surgery. SAS was defined by an ESS R10 and R5 apnoeas/hypopnoeas (central or obstructive) per hour. Results: Six of the thirteen (46%) patients had SAS. Risk factors were male gender (83.3 vs 14.3% without SAS) and long disease duration until diagnosis of acromegaly (10.2G3.2 vs 4.6G3.6 years, meanGS.D.). Ten patients had a homeostasis assessment model score R4 indicating insulin resistance and one had diabetes mellitus requiring insulin. Seven patients had hypertension (R140/90 mmHg). Postoperatively, GH and IGF-I levels decreased, but only five patients were cured. However, SAS resolved in all patients irrespective of whether acromegaly was cured or not. FBG (5.5G1.2 vs 4.8G0.4 mmol/l) and systolic blood pressure (150.8G18.5 vs 130.8G17.5 mmHg) decreased in all SAS patients. Conclusion: We found a high prevalence of SAS in acromegaly patients, in particular, in men and those with long duration of disease. Importantly, a marked reduction of GH excess by transsphenoidal adenomectomy may cure SAS and improve insulin resistance and hypertension.European Journal of Endocrinology 156 321-329

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Section: Discussionmentioning

confidence: 66%

Effect of transsphenoidal surgery on sleep apnoea in acromegaly

Sze

Schmid²,

Bloch³

et al. 2007

eur j endocrinol

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“…Both studies found that the treatment with the SA octreotide reduces IR with a slight, but significant deterioration of glucose homeostasis in the nondiabetic patients. In 1995, Breidert et al investigated eight patients' OGTT and euglycaemic clamp results before and after treatment with octreotide 300-600 mg/d with no changes for IR after treatment (12). In our cohort, b-cell function (HOMA-b) was reduced in patients on LA therapy.…”

Section: Discussionmentioning

confidence: 72%

Effects of the long-acting somatostatin analogue Lanreotide Autogel on glucose tolerance and insulin resistance in acromegaly

Steffin¹,

Gutt²,

Bidlingmaier³

et al. 2006

eur j endocrinol

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Object: Treatment with somatostatin analogues (SA) not only inhibits GH secretion but may also impair insulin secretion. In order to evaluate the influence of SA on glucose metabolism, we investigated insulin resistance (IR) and b-cell function, using the recommended combination of homeostatic model assessment of IR (HOMA-IR) and b-cell function (HOMA-b). Design and methods: This is a prospective, cross-sectional study. We measured fasting insulin, blood glucose and IGF-I. Insulin and blood glucose measurements were taken 120 min after an oral glucose tolerance test with 75 g glucose. We studied 51 patients (27 female/24 male, age 54 years (20-75)). Eighteen patients were on Lanreotide Autogel (LA) treatment, 33 had no medical treatment. GH-levels of more than 2.5 ng/ml was reached by 59% of the patients, 74.5% had normal IGF-I levels. Results: We found no significant influence of disease activity on HOMA-IR and HOMA-b. In the 33 of 51 subjects without any drug treatment, median HOMA-b was 170.4% (36.0-624.0%). In contrast, in the 18 patients on LA treatment, median HOMA-b was found to be significantly lower (84.2% (36.5-346.2%); PZ0.001). Despite this, there was no difference in HOMA-IR in both groups (2.4 (0.7-8.4) vs 2.3 (0.7-6.1); P!0.001) despite similar insulin values. Conclusion: In conclusion, we found that LA decreases b-cell function significantly without affecting IR. Therefore, we think that insulin secretagogues are probably more effective in the treatment of diabetes mellitus in acromegalic patients on LA therapy than insulin sensitizers. European Journal of Endocrinology 155 73-78

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“…Pancreatitis is rare (Neggers et al 2007). SSA suppress plasma insulin levels and were initially thought to aggravate the glucose intolerance; however, the overall effect on glucose metabolism is not clinically significant (Breidert et al 1995), probably because the effect on GH and consequently insulin resistance predominates. A meta-analysis published in 2009 confirmed that, despite the decrease of fasting insulin and possible alteration of glucose levels during OGTT, fasting plasma glucose and HbA1c do not change significantly, arguing against a clinically significant effect (Mazziotti et al 2009).…”

Section: Medical Treatmentmentioning

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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Long-Term Effect of Octreotide in Acromegaly on Insulin Resistance

Cited by 26 publications

References 7 publications

Effect of transsphenoidal surgery on sleep apnoea in acromegaly

Effect of transsphenoidal surgery on sleep apnoea in acromegaly

Effects of the long-acting somatostatin analogue Lanreotide Autogel on glucose tolerance and insulin resistance in acromegaly

60 YEARS OF NEUROENDOCRINOLOGY: Acromegaly

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