ECE2024 Poster Presentations Pituitary and Neuroendocrinology (120 abstracts)
Predictors of diabetes remission after surgery in patients with acromegaly. a series of 604 cases
Eider Pascual-Corrales 1 , Betina Biaggeti 2 , Mónica Marazuela 3 , Manel Puig-Domingo 4 , Víctor Rodríguez Berrocal 5 , Ana Irigaray 6 , Cristina Novo 7 , María Calatayud 8 , Ignacio Bernabeu 9 , Cristina Álvarez Escolá 10 , Carmen Tenorio Jimenez 7 , Inmaculada Gonzalez-Molero 11 , Pedro Iglesias 12 , Concepción Blanco 13 , Maria Paz de Miguel Novoa 14 , Elena López-Mezquita Torres 15 , Cristina Lamas 16 , Ana Aulinas Maso 17 , Paola Gracia Gimeno 18 , José María Recio 19 , Miguel Antonio Sampedro Núñez 3 , Miguel Paja Fano 20 , Maria Dolores Moure Rodriguez 21 , Carmen Fajardo-Montañana 22 , Fernando Cordido 23 , Edelmiro Luis Menendez Torre 24 , Juan Carlos Percovich 25 , Rogelio García Centeno 25 , Rosa Camara 26 , Felicia A Hanzu 27 , Almudena Vicente 28 , Laura Gonzalez Fernandez 25 , Fernando Guerrero 29 , M Dolores Ollero 6 & Marta Araujo Castro 1
1Hospital Universitario Ramón y Cajal, Endocrinology and Nutrition, Madrid, Spain; 2Hospital Universitario Vall de Hebrón, Endocrinology and Nutrition, Barcelona, Spain; 3Hospital Universitario La Princesa, Endocrinology and Nutrition, Madrid, Spain; 4Hospital Universitario Germans Trias i Pujol, Endocrinology and Nutrition, Spain; 5Hospital Universitario Ramón y Cajal, Neurosurgery, Madrid, Spain; 6Complejo Hospitalario de Navarra, Endocrinology and Nutrition, Pamplona, Spain; 7Hospital Universitario Virgen de las Nieves, Endocrinology and Nutrition, Granada, Spain; 8Hospital Universitario 12 de Octubre, Endocrinology and Nutrition, Madrid, Spain; 9Hospital Universitario de Santiago de Compostela, Endocrinology and Nutrition, Santiago de Compostela, Spain; 10Hospital Universitario La Paz, Endocrinology and Nutrition, Madrid, Spain; 11Hospital Regional Universitario de Málaga, Endocrinology and Nutrition, Málaga, Spain; 12Hospital Universitario Puerta de Hierro, Endocrinology and Nutrition, Madrid, Spain; 13Hospital Universitario Príncipe de Asturias, Endocrinology and Nutrition, Madrid, Spain; 14Hospital Clínico San Carlos, Endocrinology and Nutrition, Madrid, Spain; 15Hospital Universitario Clínico San Cecilio, Endocrinology and Nutrition, Granada, Spain; 16Hospital Universitario De Albacete, Endocrinology and Nutrition, Albacete, Spain; 17Hospital de la Santa Creu i Sant Pau, Endocrinology and Nutrition, Barcelona, Spain; 18Hospital Royo Villanova, Endocrinology and Nutrition, Zaragoza, Spain; 19Hospital Universitario de Salamanca, Endocrinology and Nutrition, Salamanca, Spain; 20Hospital Universitario de Basurto, Endocrinology and Nutrition, Bilbao, Spain; 21Hospital de Cruces, Endocrinology and Nutrition, Bilbao, Spain; 22Hospital Universitario de La Ribera, Endocrinology and Nutrition, Valencia, Spain; 23Complejo Hospitalario Universitario A Coruña, Endocrinology and Nutrition, A Coruña, Spain; 24Hospital Universitario Central de Asturias, Endocrinology and Nutrition, Oviedo, Spain; 25Hospital Universitario Gregorio Marañón, Endocrinology and Nutrition, Madrid, Spain; 26Hospital Universitario La Fe, Endocrinology and Nutrition, Valencia, Spain; 27Hospital Universitario Clinic, Endocrinology and Nutrition, Barcelona, Spain; 28Hospital Universitario de Toledo, Endocrinology and Nutrition, Toledo, Spain; 29Hospital Universitario de Bellvitge, Endocrinology and Nutrition, Barcelona, Spain
Aim: To investigate the impact of pituitary surgery on glucose metabolism and to identify predictors of diabetes remission after surgery in patients with acromegaly.
Methods: A national multicenter retrospective study of acromegaly patients undergoing transsphenoidal surgery for the first time at 33 tertiary Spanish hospitals (ACRO-SPAIN study, n=604) was performed. Surgical remission was evaluated according to the 2000 and 2010 criteria. Glucose metabolism and metabolic control were evaluated before, within 3 months after surgery and at the long-term follow up (last available visit).
Results: A total of 604 acromegaly patients were included in the study with a median follow up of 91 months (IQR 45-163). The mean age was 47.8±14.0 years and 58.9% (n=356) were women. At baseline, 23.8% of the patients had type 2 diabetes mellitus (T2DM) with a median of glycated hemoglobin (HbA1c) levels of 6.9% (IQR 6.4-7.9) and of fasting plasma glucose (FPG) levels of 143 mg/dl (IQR 124-169). We observed a positive correlation between IGF-1 levels at acromegaly diagnosis and FPG(r=0.16, P<0.001) and HbA1c(r=0.18, P=0.001) levels. No correlation between initial GH levels and FPG or HbA1c levels was found. In the multivariate analysis, an older age(OR 1.02 per each in increase in year, 95%CI 1.00-1.05), having dyslipidemia(OR 5.26, 95%CI 2.82-9.79) and higher IGF-1 levels (OR 1.30 per each increase in standard deviation above the upper limit of normal, 95%CI 1.05-1.60) were associated with a greater prevalence of T2DM. At the last follow-up visit after surgery, 53.4% of the patients achieved surgical remission based on the Cortina criteria and 41.4% based on the 2010 criteria. A significant improvement in FPG and HbA1c levels was observed in the global cohort, being greater in the group of T2DM patients(P<0.001). No differences in the rate of reduction of HbA1c or FPG levels were observed between patients pretreated and not pretreated with first generation somatostatin receptor ligands; neither between patients cured of acromegaly after surgery and those who did not. After surgery, 21.3% of the T2DM patients, 56.7% of them with surgical remission of acromegaly(2010criteria), experienced diabetes remission. The cure of T2DM was more common in older patients(HR 1.77), when surgical cure was achieved(HR 2.10) and when anterior pituitary function was not affected after surgery(HR 3.38).
Conclusion: Glucose metabolism improved in patients with acromegaly after surgery, especially in T2DM patients. The remission of T2DM was more frequent in patients with older age, with surgical cure and preserved anterior pituitary function after surgery.
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Endocrine Abstracts
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