title: Improvement of endothelial dysfunction in acromegaly after transsphenoidal surgery.
abstract: Flow-mediated vasodilatation (FMD) is a vascular functional test to detect endothelial dysfunction at the early stage of cardiovascular diseases. Patients with active acromegaly have higher morbidity and mortality due to cardiovascular events. To determine whether active acromegaly is associated with endothelial dysfunction, we studied 17 patients with active acromegaly for measurements of FMD, carotid intima-media thickness (IMT) and brachial-ankle pulse wave velocity (baPWV), and other biochemical parameters before and 3 months after transsphenoidal surgery (TSS). Baseline %FMD in patients with active acromegaly was significantly lower than that in age- and sex-matched control subjects. After TSS, the mean %FMD in acromegaly significantly increased from 5.3% to 7.4%; 12 patients had increased %FMD (responders), whereas 5 patients had decreased or unchanged %FMD (non-responders). However, neither carotid IMT nor baPWV changed after TSS. Serum levels of GH, insulin-like growth factor (IGF)-1, total cholesterol, low-density lipoprotein cholesterol (LDL-C), hemoglobin HA(1C), fasting plasma glucose and insulin levels, and homeostasis model assessment (HOMA)-R significantly decreased, whereas high-density lipoprotein cholesterol significantly increased. Responders had significantly lower baseline %FMD than did non-responders and both insulin levels and HOMA-R significantly decreased in responders, but not in non-responders after TSS. Simple regression analysis revealed that the change of %FMD showed a significant negative correlation with that of LDL-C, but not of IGF-1 or GH, in responders. In conclusion, it is suggested that endothelial dysfunction associated with active acromegaly improves soon after TSS, which is related to LDL-C and/or insulin resistance, but not to excess GH and/or IGF-1 itself.
authors.affiliation: Department of Clinical and Molecular Endocrinology, Tokyo Medical and Dental University Graduate School, Japan.
authors.forename: Haruna
authors.initials: H
authors.lastname: Sakai
authors.forename: Kyoichiro
authors.initials: K
authors.lastname: Tsuchiya
authors.forename: Chisato
authors.initials: C
authors.lastname: Nakayama
authors.forename: Fumiko
authors.initials: F
authors.lastname: Iwashima
authors.forename: Hajime
authors.initials: H
authors.lastname: Izumiyama
authors.forename: Masaru
authors.initials: M
authors.lastname: Doi
authors.forename: Takanobu
authors.initials: T
authors.lastname: Yoshimoto
authors.forename: Motohiro
authors.initials: M
authors.lastname: Tsujino
authors.forename: Shozo
authors.initials: S
authors.lastname: Yamada
authors.forename: Yukio
authors.initials: Y
authors.lastname: Hirata
mesh_terms: D000172:Acromegaly / Q000503:physiopathology* / Q000601:surgery*; D000328:Adult; D001783:Blood Flow Velocity; D001916:Brachial Artery; D002339:Carotid Arteries / Q000473:pathology; D008078:Cholesterol, LDL / Q000097:blood; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D005951:Glucose Tolerance Test; D006339:Heart Rate; D019382:Human Growth Hormone / Q000097:blood; D006801:Humans; D007333:Insulin Resistance; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D017539:Tunica Intima / Q000473:pathology; D014664:Vasodilation
chemical_list: D008078:Cholesterol, LDL; D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I