title: Comparison between six-year therapy with long-acting somatostatin analogs and successful surgery in acromegaly: effects on cardiovascular risk factors.
abstract: BACKGROUND
  The effects of chronic therapy with long-acting somatostatin analogs (SSTa) on metabolic and cardiovascular parameters have been partially elucidated in acromegalic patients.
  
  
  OBJECTIVE
  The objective of this study was to compare the long-term effects of SSTa treatment and successful surgery on GH/IGF-I secretion and cardiovascular risk parameters in acromegaly. DESIGN, PATIENTS, AND INTERVENTION: This was a retrospective study of 36 acromegalic patients treated with SSTa and evaluated after a median of 66 months and of 33 sex-, age-, and body mass index-matched cured patients evaluated after a similar period of remission, all from the Institute of Endocrine Sciences (Milan, Italy).
  
  
  METHODS
  The main outcome measures were fasting and post-oral load glucose homeostasis, hemoglobin A(1c), insulin sensitivity and secretion by several indexes, lipid profile, and blood pressure.
  
  
  RESULTS
  Fasting and areas under the glucose response curve rose in patients controlled (n = 29) and not controlled (n = 7) by SSTa, becoming higher than those in cured subjects. A 1% hemoglobin A(1c) increase was observed in all nondiabetic SSTa patients, but not in cured subjects. Basal insulin secretion and resistance, evaluated by homeostasis model assessment, decreased in all SSTa patients, whereas oral glucose tolerance test-derived insulin secretion and resistance, evaluated by insulinogenic index and oral glucose tolerance test-derived insulin secretion, improved only in SSTa-treated controlled patients. Triglycerides did not change during SSTa, whereas high-density lipoprotein cholesterol increased in SSTa-treated controlled patients. At the last visit, the contemporary presence of at least three cardiovascular risk factors was more frequent in patients treated with SSTa than in cured subjects.
  
  
  CONCLUSIONS
  SSTa therapy induces long-lasting disease control and improvement of insulin sensitivity and high-density lipoprotein cholesterol levels in responsive patients. The progressive glucose homeostasis alterations, observed independently from the degree of cure, suggest the need for glucose homeostasis and peripheral vascular complications monitoring during chronic SSTa treatment.
authors.affiliation: Institute of Endocrine Sciences, Fondazione Instituto di Ricovero e Cura a Carattere Scientifico, Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, 20122 Milan, Italy. cristina.ronchi@unimi.it
authors.forename: Cristina L
authors.initials: CL
authors.lastname: Ronchi
authors.forename: Virginia
authors.initials: V
authors.lastname: Varca
authors.forename: Paolo
authors.initials: P
authors.lastname: Beck-Peccoz
authors.forename: Emanuela
authors.initials: E
authors.lastname: Orsi
authors.forename: Francesca
authors.initials: F
authors.lastname: Donadio
authors.forename: Andrea
authors.initials: A
authors.lastname: Baccarelli
authors.forename: Claudia
authors.initials: C
authors.lastname: Giavoli
authors.forename: Emanuele
authors.initials: E
authors.lastname: Ferrante
authors.forename: Andrea
authors.initials: A
authors.lastname: Lania
authors.forename: Anna
authors.initials: A
authors.lastname: Spada
authors.forename: Maura
authors.initials: M
authors.lastname: Arosio
mesh_terms: D000172:Acromegaly / Q000188:drug therapy* / Q000532:radiotherapy / Q000601:surgery*; D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance / Q000502:physiology; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D012307:Risk Factors; D013004:Somatostatin / Q000031:analogs & derivatives* / Q000097:blood / Q000627:therapeutic use*; D049629:Waist-Hip Ratio
chemical_list: D001786:Blood Glucose; D007328:Insulin; D013004:Somatostatin