Endocrine Abstracts

Acromegaly (A) is associated with the bone overgrowth and soft tissue abnormalities due to anabolic, lipolytic and sodium retaining actions of GH.

Aim: To investigate the effects of medical treatment on bone mineral density (BMD) of proximal femur, lumbar spine and tissue distribution. We observed 56 patients (14 M and 42 F) with A. BMD was measured using dual-energy X-ray absorptiometry with ‘total body’ program. The patients were treated with Sandostatin® LAR® in dose 20–40 mg/28 days. Patients were distributed into two groups: Group I – 24 patients with active A (53.5±12.6 years old (Mean±S.D.), BMI – 32.6±7.1 kg/m²; IGF1 – 614.3±286.7 ng/ml), Group II – 32 cured patients (58.8±9.8 years old, BMI – 31.8±14.9 kg/m², IGF1 – 186.9±50.0 ng/ml). The control group (Group III) included 18 healthy volunteers (6 M and 12 F) aged 55.4±8.0 years old and BMI 30.0±3.6 kg/m². Osteopenia (T or Z criteria (depending on the age) <−1.0 and >−2.5) was diagnosed in 21% patients of Group I, in 31% patients of the Group II and in 44% in controls. A moderate correlation was revealed between IGF1 value and mineral bone mass (r=0.43; P<0.05), proximal femur T or Z criteria (r=0.43; P<0.05). Correlation between the age and femur T or Z criteria was stronger in Group III in comparison with the Group I (r=−0.72 and r=−0.47, respectively; P<0.05). An age-specific osteopenia had lesser prevalence in Group I comparing with controls in contrast to Group II. This data shows the protective role of IGF1 on BMD. Spondyls diameter in patients of Group I was significantly bigger than in control group. Lean mass in Group I was significantly higher than in Groups II and III. Peculiarities in tissue distribution correlates with IGF1 level. The positive correlation (r=0.52; P<0.05) was found between the lean mass and the value of IGF1. The overall lean mass growth in the Group I is mainly distributed in the abdomen area in contrast to other groups.

Conclusion: i) Development and treatment of A. are accompanied by different functional and morphological alterations which require the additional therapeutic intervention. ii) After the normalization IGF1 value its protective action on BMD decreases and such patients don’t differ from the subjects of the same age by tissue distribution and overall BMD. iii) The investigation of the spine in patients with A is less informative for the diagnostic of BMD due to the bone overgrowth this area (osteophyte growth, intervertebral disk ossification and diameter extension).