The impact of transsphenoidal surgery on glucose homeostasis and insulin resistance in acromegaly

Abstract

We conclude that in acromegalic patients glucose homeostasis alterations and insulin sensitivity can be normalized after transsphenoidal surgery, even if strict biochemical cure criteria are not fulfilled.

Evolution of Glucose Tolerance After Treatment of Acromegaly: A Study in 57 Patients

“…A recent Italian epidemiological study also found a 3-fold increase of the prevalence of diabetes in acromegalic patients compared to the Italian population [7]. Furthermore, we also confirmed that at diagnosis most patients with acromegaly exhibit reduced insulin sensitivity, as previously reported [1,3,12,14,24,29] and that patients with diabetes have a more pronounced decrease of β-cell function, suggesting insufficient capacity of pancreatic beta-cells to counterbalance the insulin resistance [1]. This is likely related in part to predisposing factors other than GH hypersecretion, such as a positive familial history for diabetes, aging, or increased BMI.…”

“…This was also confirmed in treated patients by the positive correlation between changes in fasting glucose and in IGF-I but not GH. Thus, we confirm that IGF-I concentration, which reflects integrated 24-h GH secretion [24,35] is better than a fasting GH level as predictor of glucose tolerance status [3,14,24,25,29,36]. This is likely due to the greater stability of circulating total IGF-I.…”

“…A high BMI, older age, and family history of diabetes as well as the age-related IGF-I concentration at diagnosis have been identified as independent risk factors for these metabolic complications [3,9]. Data concerning the evolution of glucose tolerance after treatment of acromegaly and the relative impact of the various treatments applied are less abundant and still conflicting, not always taking into account disease activity and previous glucose tolerance status [9][10][11][12][13][14]. Thus, the reported frequency of IGT and diabetes after treatment of acromegaly is highly variable, ranging between 0 and 58 % for IGT and between 0 and 46 % for diabetes [9][10][11][12][13][14][15].…”

“…Data concerning the evolution of glucose tolerance after treatment of acromegaly and the relative impact of the various treatments applied are less abundant and still conflicting, not always taking into account disease activity and previous glucose tolerance status [9][10][11][12][13][14]. Thus, the reported frequency of IGT and diabetes after treatment of acromegaly is highly variable, ranging between 0 and 58 % for IGT and between 0 and 46 % for diabetes [9][10][11][12][13][14][15]. Hypertension [16] and persistently high IGF-I levels after surgery [9] ▼ The aim of our study was to evaluate the evolution of glucose metabolism in 57 patients after treatment of their acromegaly and to determine risk factors for the persistence of abnormal glucose tolerance.…”

Preoperative octreotide therapy and surgery in acromegaly: associations between glucose homeostasis and treatment response

“…This is probably due to adenoma debulking causing improvement in GH and IGF-1 after surgery [51]. This is in contrast to worsening of the parameters after unsuccessful SSA treatment and in line [32,47], and in patients with successful surgery both plasma glucose and insulin sensitivity improve significantly [8,52,53]. To our knowledge, this is the first study to demonstrate that glucose metabolism is significantly improved postoperatively also in the patients that are not cured by surgery.…”