Endocrine Abstracts

Introduction: Excess GH in acromegaly has lipolytic action and detrimental effect on glucose metabolism and insulin signaling. Recent studies have suggested a specific lipodystrophy in patients with acromegaly. Paradoxically, although the visceral adipose tissue (VAT) and intrahepatic lipid were reduced in active acromegaly compared to controls, insulin resistance was increased. Fat was redistributed from subcutaneous and visceral depots to muscle; weight and VAT depots rose with surgical or medical therapy. The aim of our study was to assess the weight and glycemic changes in Romanian patients treated with surgery for acromegaly.

Patients and methods: Retrospective evaluation of weight, height, body mass index (BMI), blood glucose levels in 26 patients (6 men, 20 women) with active acromegaly, not treated with somatostatin analogs, before and at 3 to 6 months after surgery.

Results: Mean age before surgery was 51 ± 12 years. In 12 patients (46%) IGF1 and/or GH levels were controlled after surgery (IGF1<1.3xULN). Pituitary insufficiency was recorded in 3 patients (11.5%) and diabetes mellitus in 5 (19%) before surgery, and in 4 (15.3%) and 6 (23%), respectively, after surgery (p=NS). Overall, mean body weight increased significantly after surgery, from 79.7 to 82.3 kg (P<0.01), BMI tended to increase (27.5 to 29.5 kg/sqm, P=0.055). In contrast to other studies, weight increased significantly only in patients not controlled after surgery: 80.5 to 82.5 kg, P<0.01, 2 (14%) with glucocorticoid replacement after surgery. Mean glycemia ( mg/dL) decreased after surgery from 124.3 to 102.5 (P< 0.01), notably in controlled patients (106 to 91.5, P<0.01) and borderline in uncontrolled ones (105 to 96.5, P=0.058).

Conclusion: In patients with acromegaly, although body weight increased after surgery, blood glucose levels improved, suggesting different pathophysiologic mechanisms regulating fat and glucose metabolism, as compared to non-acromegalic patients with metabolic syndrome.