title: Glucose homeostasis in patients with acromegaly treated with surgery or somatostatin analogues.
abstract: OBJECTIVE
  Long-acting somatostatin analogues (SSA) are widely used for the treatment of acromegaly; however, they also alter β-cell function by inhibiting insulin secretion. In this study, we assess the effect of SSA on glucose homeostasis in patients with acromegaly treated with SSAs, compared to patients treated with surgery.
  
  
  METHODS
  We studied four groups of patients with acromegaly: at the time of diagnosis (group I, n = 53), after successful transsphenoidal surgery (TSS, group II, n = 30) and under successful SSA treatment (group III, n = 20); 22 patients were studied only before treatment, 19 only post-treatment, while 31 patients (group IV) were studied before and after the treatment.
  
  
  METHODS
  Patients underwent an oral glucose tolerance test. Insulin sensitivity and β-cell insulin secretion were estimated using appropriate mathematical models.
  
  
  RESULTS
  Control of acromegaly with either TSS or SSA improved insulin sensitivity as evident by significantly lower fasting and postglucose insulin levels and HOMA-IR. In addition, patients of group III compared to patients of group II demonstrated significantly lower HOMA-β% (52·5 ± 10·9 vs 189·6 ± 86·7, P < 0·05) and lower first and second phase insulin release (443 ± 83·5 vs 1077 ± 140·8, P < 0·05 and 150 ± 18·2 vs 285 ± 33·3, P < 0·05), respectively. Also, lower fasting glucose levels and a lower prevalence of diabetes were noted in group II compared to group III (5·1 ± 0·2 vs 6·2 ± 0·2 mm, P < 0·05, and 13·3%vs 40%, P < 0·0031, respectively). CONCLUSIONS; Control of acromegaly with SSA seems to exhibit a negative effect on pancreatic β-cell function. Whether this has long-term clinical implications remains to be established. Nevertheless, careful monitoring of glucose metabolism in patients under SSA is beneficial for their optimal management.
authors.affiliation: Department of Endocrinology, "Evangelismos Hospital", Athens, Greece.
authors.forename: Marinella
authors.initials: M
authors.lastname: Tzanela
authors.forename: Dimitra A
authors.initials: DA
authors.lastname: Vassiliadi
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Gavalas
authors.forename: Andrea
authors.initials: A
authors.lastname: Szabo
authors.forename: Eleni
authors.initials: E
authors.lastname: Margelou
authors.forename: Athina
authors.initials: A
authors.lastname: Valatsou
authors.forename: Charalambos
authors.initials: C
authors.lastname: Vassilopoulos
mesh_terms: D000172:Acromegaly / Q000188:drug therapy / Q000378:metabolism / Q000601:surgery; D001786:Blood Glucose / Q000032:analysis; D005260:Female; D005947:Glucose / Q000378:metabolism*; D006706:Homeostasis / Q000187:drug effects / Q000502:physiology*; D006801:Humans; D007328:Insulin / Q000097:blood*; D007333:Insulin Resistance / Q000502:physiology; D050417:Insulin-Secreting Cells / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D013004:Somatostatin / Q000009:adverse effects / Q000031:analogs & derivatives / Q000494:pharmacology
chemical_list: D001786:Blood Glucose; D007328:Insulin; D013004:Somatostatin; D005947:Glucose