title: Urinary calcium excretion and insulin resistance in patients with acromegaly.
abstract: BACKGROUND
  Renal complications in acromegaly include glomerular hyperfiltration, insulin resistance, hypercalciuria and urolithiasis. The aim of this study was to investigate whether urinary calcium (U(Ca)) excretion is a direct consequence of growth hormone secretion or secondary to hyperfiltration and/or insulin resistance.
  
  
  METHODS
  We performed a cross-sectional study of 58 patients diagnosed with acromegaly. Demographic data were obtained, serum analysis was performed, including insulin-like growth factor (IGF)-1, and 24-h urine collection, to measure urinary protein excretion, U(Ca) and phosphate excretion, as well as fractional excretion of sodium and potassium. We also calculated the homeostasis model assessment of insulin resistance (HOMA-IR).
  
  
  RESULTS
  Patients were predominantly male (60.3%), and their mean age was 45.9 ± 14 years. Hypercalciuria was present in 24% of patients. Patients with higher HOMA-IR had higher IGF-1 levels, a trend toward higher body mass index and higher U(Ca) excretion. In univariate analysis, U(Ca) excretion was associated with HOMA-IR (r = 0.472, P = 0.001), phosphaturia (r = 0.457, P = 0.001), IGF-1 (r = 0.398, P = 0.002) and creatinine clearance (r = 0.394, P = 0.001). HOMA-IR and phosphaturia were independently associated with U(Ca) excretion. No independent associations were found between phosphaturia and HOMA-IR or IGF-1.
  
  
  CONCLUSIONS
  The present study revealed an association between hypercalciuria and insulin resistance in patients with acromegaly. Further studies are required to fully understand the pathogenesis of these abnormalities in patients with acromegaly.
authors.affiliation: Division of Nephrology, Hospital Geral de Fortaleza, Fortaleza, Ceará, Brazil. alexandreliborio@yahoo.com.br
authors.forename: Alexandre Braga
authors.initials: AB
authors.lastname: Libório
authors.forename: Patrícia R L
authors.initials: PR
authors.lastname: Figueiredo
authors.forename: Renan M
authors.initials: RM
authors.lastname: Montenegro Junior
authors.forename: Renan M
authors.initials: RM
authors.lastname: Montenegro
authors.forename: Manoel R A
authors.initials: MR
authors.lastname: Martins
authors.forename: Geraldo B
authors.initials: GB
authors.lastname: Silva Junior
authors.forename: Ivna Aguiar
authors.initials: IA
authors.lastname: Porto
authors.forename: José Italo Soares
authors.initials: JI
authors.lastname: Mota
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Daher
mesh_terms: D000172:Acromegaly / Q000150:complications / Q000378:metabolism / Q000652:urine*; D000328:Adult; D015992:Body Mass Index; D002118:Calcium / Q000652:urine*; D003404:Creatinine / Q000652:urine; D003430:Cross-Sectional Studies; D005260:Female; D013006:Growth Hormone / Q000378:metabolism; D006706:Homeostasis; D006801:Humans; D053565:Hypercalciuria / Q000150:complications*; D007333:Insulin Resistance; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010710:Phosphates / Q000652:urine; D011188:Potassium / Q000652:urine; D011507:Proteinuria / Q000652:urine; D012964:Sodium / Q000652:urine
chemical_list: D010710:Phosphates; D007334:Insulin-Like Growth Factor I; D013006:Growth Hormone; D012964:Sodium; D003404:Creatinine; D011188:Potassium; D002118:Calcium