title: The metabolic profile in active acromegaly is gender-specific.
abstract: BACKGROUND
  The sexual dimorphism of the somatotroph axis has been documented, but whether the acromegaly-related metabolic alterations are gender-dependent has never been investigated.
  
  
  OBJECTIVE
  The aim of the study was to evaluate the impact of gender on the metabolic parameters in acromegaly.
  
  
  METHODS
  We conducted a retrospective, comparative, multicenter study.
  
  
  METHODS
  The 307 newly diagnosed acromegalic patients included in the study were grouped by gender: 157 men (aged 48.01 ± 14.28 yr), and 150 women (aged 48.67 ± 14.95 yr; of which 77 were premenopausal and 73 postmenopausal).
  
  
  METHODS
  We measured each component of the metabolic syndrome (MS), hemoglobin A1c, the areas under the curve (AUCs) of glucose and insulin during 2-h oral glucose tolerance test, basal insulin resistance using the homeostasis model assessment of the insulin resistance index, stimulated insulin sensitivity using the insulin sensitivity index, early insulin-secretion rate using the insulinogenic index, β-cell function relative to insulin sensitivity using the oral disposition index and the visceral adiposity index (VAI) as the surrogate of visceral fat function.
  
  
  RESULTS
  Women showed a higher prevalence of MS (P < 0.001), higher fasting insulin levels (P < 0.001), AUC for insulin (P = 0.002), homeostasis model assessment of the insulin resistance index (P < 0.001), and VAI (P < 0.001) and a lower insulin sensitivity index (P = 0.002) than men, whereas no difference was found in fasting glucose, AUC for glucose, hemoglobin A1c, insulinogenic index, and oral disposition index. In women, fasting glucose and fasting insulin showed a significant trend toward increase (P < 0.001) and decrease (P = 0.004), respectively, from the first to the fourth quartiles of age, whereas VAI showed a trend toward increase in both groups (P < 0.001). A significantly higher prevalence of MS (P < 0.001), increased waist circumference (P < 0.001), low high-density lipoprotein cholesterol (P < 0.001), and overt diabetes mellitus (P < 0.001) was found in postmenopausal women compared with premenopausal women, as well as with men.
  
  
  CONCLUSIONS
  The majority of metabolic features in acromegaly are gender-specific. Active acromegaly in women is strongly associated with higher visceral adiposity dysfunction, insulin resistance, and the features of MS. We suggest more accurate metabolic management in acromegalic women, especially in the postmenopausal years.
authors.affiliation: Biomedical Department of Internal and Specialist Medicine, Section of Endocrinology, University of Palermo, 90127 Palermo, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Ciresi
authors.forename: M C
authors.initials: MC
authors.lastname: Amato
authors.forename: R
authors.initials: R
authors.lastname: Pivonello
authors.forename: E
authors.initials: E
authors.lastname: Nazzari
authors.forename: L F
authors.initials: LF
authors.lastname: Grasso
authors.forename: F
authors.initials: F
authors.lastname: Minuto
authors.forename: D
authors.initials: D
authors.lastname: Ferone
authors.forename: A
authors.initials: A
authors.lastname: Colao
authors.forename: C
authors.initials: C
authors.lastname: Giordano
mesh_terms: D000172:Acromegaly / Q000097:blood / Q000378:metabolism*; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D015331:Cohort Studies; D005215:Fasting / Q000097:blood / Q000378:metabolism; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance / Q000502:physiology; D050152:Intra-Abdominal Fat / Q000378:metabolism / Q000473:pathology; D008297:Male; D055442:Metabolome / Q000502:physiology*; D008875:Middle Aged; D012189:Retrospective Studies; D012727:Sex Characteristics
chemical_list: D001786:Blood Glucose; D007328:Insulin