Glucose tolerance and somatostatin analog treatment in acromegaly: a 12-month study.
OBJECTIVE
The objective of the study was to investigate the impact of first-line somatostatin analogs (SSAs) on glucose tolerance (GT) in acromegaly.


METHODS
The design was open and prospective.


METHODS
One hundred twelve patients [63 with normal GT (56.2%), 24 with impaired GT (21.4%), and 25 with diabetes (22.3%)] were treated with depot SSAs for 12 months: 54 patients (48.2%) achieved mean fasting GH levels less than 2.5 microg/liter in presence of normal IGF-I levels (controlled) during SSA.


METHODS
Fasting glucose and glycosylated hemoglobin levels were measured.


RESULTS
At study end, 57 patients had normal GT (50.1% vs. baseline; P = 0.55), 30 had impaired fasting glucose or impaired GT (26.8%, P =0.43) and 25 had diabetes (22.3%; P = 1.0). Twenty-eight patients (25.0%), modified their GT [11 improved (9.8%), 17 worsened (15.2%)]: 90% of the patients with GT improvement achieved control of acromegaly and 89% of those having GT worsening did not (P < 0.0001). The major predictors of GT changing were disease control (t = -4.99; P < 0.0001), baseline GT (t = -2.84; P = 0.0054), and GH levels (t = 2.70; P = 0.008). Fasting glucose levels were predicted by patients' age (t = 2.74; P = 0.0071) and IGF-I levels (t = 2.14; P = 0.035). Glycosylated hemoglobin levels were predicted by disease duration (t = 3.53; P = 0.0006), GH levels (t = 2.70; P = 0.0071), and IGF-I levels (t = 2.11; P = 0.037).


CONCLUSIONS
This study showed a similar prevalence of deterioration and improvement of GT 12 months after first-line SSA treatment. Uncontrolled acromegaly during SSA treatment and abnormal GT at baseline were associated with GT worsening.
Colao
Annamaria
A
Department of Molecular and Clinical Endocrinology and Oncology, Federico II University of Naples, via S. Pansini 5, Naples, Italy. colao@unina.it
Auriemma
Renata S
RS
Savastano
Silvia
S
Galdiero
Mariano
M
Grasso
Ludovica F S
LF
Lombardi
Gaetano
G
Pivonello
Rosario
R
D000172:Acromegaly / Q000188:drug therapy* / Q000378:metabolism; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D003920:Diabetes Mellitus / Q000188:drug therapy; D005260:Female; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013004:Somatostatin / Q000031:analogs & derivatives* / Q000627:therapeutic use
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D013004:Somatostatin; C517652:hemoglobin A1c protein, human