Endocrine Abstracts

Background: Acromegaly is a rare chronic and debilitating disease. More than half of patients are not well controlled and most of them require chronic surveillance. Although IGF1 and GH circulating levels are the main targets, they are not in close relationship with the behaviour of the tumour, the clinical course of the disease, the therapy response and the associated comorbidities. Metabolomics is an emergent research tool that we have used to examine in a massive manner the metabolic fingerprint of the chronic exposure to GH and its change after receiving treatment.

Objective: 1) To identify metabolites and pathways which could be used as biomarkers of the disease. 2) To explore whether metabolomics could be useful to identify those patients with active disease form those under control by using pharmacological treatment or already cured.

Methods: We compared the serum metabolic fingerprint of 30 patients with acromegaly (16 males and 14 females) and 30 controls matched by age, gender, body mass index (BMI) and smoking habit. Regarding the status of the disease, 5 presented active disease defined by elevated IGF-1 and, 25 had IGF1 concentrations within the specific age-adjusted normal values (14 under medical treatment and 11 in remission or cured).

Results: Patients with acromegaly presented less BCAAs, valine and isoleucine, compared to the control group (valine: 4.50±0.21 AU vs 5.26±0.17 AU, P<0.05; isoleucine: 2.48±0.02 AU vs. 2.80±0.08 AU, P<0.05). BCAAs were lower in those patients with active disease in comparison with patients with normal serum IGF-1 (valine 4.35±0.23 AU vs. 5.01±0.12 AU; isoleucine 5.10 0.32 vs 5.62±0.28 AU; respectively, P<0.05).

Conclusions: The main metabolic fingerprint of acromegaly is a decrease in BCAAs (i.e. valine and isoleucine). The metabolic abnormalities could help to identify active disease and to monitoring the response to several therapeutic strategies. These findings could also open up a new research area in adjuvant nutritional support in patients with active acromegaly. However, further studies to confirm this preliminary results are needed.