Is there any relation between hyperinsulinemia, insulin resistance and colorectal lesions in patients with acromegaly?
BACKGROUND
Pathogenesis of colonic lesions in patients with acromegaly remains still unclear. There are suggestions that apart from somatotropin axis hormones (GH and IGF-1), other agents also take part in this process. Molecular and animal studies indicate a vital role of hyperinsulinemia in development of colorectal neoplasms.


OBJECTIVE
To evaluate a relation between insulin level, insulin resistance and its anthropometric markers and colorectal lesions in patients with acromegaly.


METHODS
The study consisted of 40 patients with active, newly diagnosed acromegaly; 24 women and 16 men aged from 24 to 77 years (mean age 50.1, SD+/-12.1). The analysis included the results of somatotropin axis function (GH and IGF-1 level), carbohydrate metabolism assessment (fasting serum glucose and insulin levels, oral glucose tolerance test, HOMA-IR for insulin resistance), the results of anthropometric measurement (BMI, WHR) and colonoscopy.


RESULTS
Colon pathologies (60 polyps and 2 flat lesions) were discovered in 19 (47.5%) patients with acromegaly, 8 of them had multiple polyps. Hyperplastic polyps were revealed in 11 (27.5%), while adenomas in 8 (20%) acromegalics. Patients with colorectal lesions were found to have higher WHR then subjects with normal colon (p=0.033). Positive correlation between the number of hyperplastic polyps in the patients with multiple changes in the colon and IGF-1 (p=0.025), insulin level (p=0.005) and HOMA-IR (p=0.001) was found. Multiple adenomas correlated positively with insulin level (p=0.007), HOMA-IR (p=0.006) and BMI (p=0.015).


CONCLUSIONS
The study results show a relation between hyperinsulinemia, insulin resistance and colon pathologies in acromegaly. Fasting insulin level and HOMA-IR correlate positively with the number of hyperplastic polyps and adenomas in acromegalic patients with multiply colorectal lesions.
Foltyn
Wanda
W
Division of Endocrinology, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Zabrze, Poland. wandafoltyn@poczta.onet.pl
Kos-Kudla
Beata
B
Strzelczyk
Janusz
J
Matyja
Violetta
V
Karpe
Jacek
J
Rudnik
Adam
A
Marek
Bogdan
B
Kajdaniuk
Dariusz
D
Sieron
Aleksander
A
Latos
Wojciech
W
D000172:Acromegaly / Q000150:complications* / Q000503:physiopathology; D000236:Adenoma / Q000209:etiology* / Q000503:physiopathology; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D003111:Colonic Polyps / Q000209:etiology* / Q000503:physiopathology; D015179:Colorectal Neoplasms / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D013006:Growth Hormone / Q000097:blood; D006706:Homeostasis / Q000502:physiology; D006801:Humans; D006946:Hyperinsulinism / Q000150:complications*; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance / Q000502:physiology*; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D012727:Sex Characteristics; D049629:Waist-Hip Ratio
D001786:Blood Glucose; D007328:Insulin; D007334:Insulin-Like Growth Factor I; D013006:Growth Hormone