ECE2023 Poster Presentations Pituitary and Neuroendocrinology (123 abstracts)
Diabetes Mellitus Secondary to Cushing’S Disease or Acromegaly: a Single-Centre Experience
Roberta Scairati 1 , Sara Di Meglio 1 , Rosa Pirchio 1 , Alice Vergura 1 , Nicola Di Paola 1 , Angelica Larocca 1 , Guendalina Del Vecchio 1 , Chiara Simeoli 1 , Renata Simona Auriemma 1 , Annamaria Colao 1,2 & Rosario Pivonello 1,2
1Dipartimento di Medicina Clinica e Chirurgia, Università Federico II di Napoli, Naples, Italy; 2UNESCO Chair for Health Education and Sustainable Development, Federico II University, Naples, Italy
Rationale: Type 2 diabetes mellitus (DM) is common in patients with Cushing’s disease (CD) and Acromegaly (AC), and contributes to increased mortality. This study aimed at investigating the prevalence and characteristics of DM in CD and AC patients at diagnosis and after disease control (DC).
Patients and Methods: 34 CD patients (8M,26F, 24 microadenomas(mA),6 macroadenomas (MMA) and 4 empty sella) and 35 AC patients (16M,19F, 7 mA,28 MMA) were included in the study. Anthropometric, biochemical and hormonal parameters, tumor size (TS), disease and DM duration were registered in the entire patient cohort.
Results: At diagnosis, among CD 22 patients had DM (64.6%), 10 IGT/IFG (29.4%) and 2 NGT (6%). In CD patients without DM, ACTH correlated with weight (r=0.71, P=0.001) and HOMA-IR (r=0.72; P=0.02); serum cortisol (SC) with total cholesterol (TC, r=0.73, P=0.007), and urinary free cortisol (UFC) with fasting glucose (FG, r=0.81, P=0.009) and HbA1c (r=0.71, P=0.02). In patients with CD and DM, age at onset correlated with HOMA-IR (r=0.53, P=0.019) and HbA1c (r=0.49, P=0.03). In the entire CD cohort, ACTH was the best predictor of insulin levels (FI, P=0.004). At diagnosis, among AC 16 patients had DM (45.7%), 17 IGT/IFG (48.5%) and 2 NGT (5.8%). In AC patients without DM, age at diagnosis correlated with TS (r=-0.71, P<0.001) and FG (r=0.47, P=0.04), and GH with TC (r=0.73, P<0.001). In the entire AC cohort, age at onset correlated with weight (r=-0.37, P=0.02), waist circumference (W, r=-0.34, P=0.04) and FI (r=-0.37, P=0.04 ), while GH with TC (r=0.63, P<0.001) and triglycerides (TG, r=0.8, P<0.001). 26 CD (76.4%) and 30 AC (85.7%) were re-evaluated at DC, and all had DM. At DC, age correlated with UFC in CD (r=-0.42; P=0.03); in AC, FG was significantly higher (P=0.007) and TG lower (P=0.04) in patients treated with somatostatin analogues (SRL) than in those treated with SRL+pegvisomant (PEG).
Conclusions: In CD patients, ACTH and SC influence glucose and lipid metabolism, while UFC affects mainly glucose metabolism, and ACTH is the best predictor of FI. In AC patients, GH impact on glucose metabolism adds to the detrimental effect of ageing. Despite achieving disease control, the metabolic damage was only partially reverted in CD, suggesting a mechanism of IR independent of hormonal correction; in AC, DC allows the most pronounced IR improvement, especially in PEG-treated patients.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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