title: A comprehensive study of clinical, biochemical, radiological, vascular, cardiac, and sleep parameters in an unselected cohort of patients with acromegaly undergoing presurgical somatostatin receptor ligand therapy.
abstract: BACKGROUND
  Attainment of safe GH and IGF-1 levels is a central goal of acromegaly management.
  
  
  OBJECTIVE
  The aim of this study was to determine the extent to which reductions in GH and IGF-1 concentrations correlate with amelioration of radiological, metabolic, vascular, cardiac, and respiratory sequelae in a single unselected patient cohort.
  
  
  METHODS
  This was a prospective, within-subject comparison in 30 patients with newly diagnosed acromegaly (15 women and 15 men: mean age, 54.3 years; range, 23-78 years) before and after 24 weeks of lanreotide Autogel (ATG) therapy.
  
  
  RESULTS
  Reductions in GH and IGF-1 concentrations and tumor volume were observed in all but 2 patients (median changes [Δ]: GH, -6.88 μg/L [interquartile range -16.78 to -3.32, P = .000001]; IGF-1, -1.95 × upper limit of normal [-3.06 to -1.12, P = .000002]; and pituitary tumor volume, -256 mm(3) [-558 to -72.5, P = .0002]). However, apnea/hypopnea index scores showed highly variable responses (P = .11), which were independent of ΔGH or ΔIGF-1, but moderately correlated with Δweight (R(2) = 0.42, P = .0001). Although systolic (P = .33) and diastolic (P = .76) blood pressure were unchanged, improvements in arterial stiffness (aortic pulse wave velocity, -0.4 m/s [-1.2 to +0.2, P = .046]) and endothelial function (flow mediated dilatation, +1.73% [-0.32 to +6.19, P = .0013]) were observed. Left ventricular mass index regressed in men (-11.8 g/cm(2) [-26.6 to -1.75], P = .019) but not in women (P = .98). Vascular and cardiac changes were independent of ΔGH or ΔIGF-1 and also showed considerable interindividual variation. Metabolic parameters were largely unchanged.
  
  
  CONCLUSIONS
  Presurgical ATG therapy lowers GH and IGF-1 concentrations, induces tumor shrinkage, and ameliorates/reverses cardiac, vascular, and sleep complications in many patients with acromegaly. However, responses vary considerably between individuals, and attainment of biochemical control cannot be assumed to equate to universal complication control.
authors: Metabolic Research Laboratories, Institute of Metabolic Science, University of Cambridge, Box 289, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom.
authors: Anand K
authors: AK
authors: Annamalai
authors: Alison
authors: A
authors: Webb
authors: Narayanan
authors: N
authors: Kandasamy
authors: Maysoon
authors: M
authors: Elkhawad
authors: Samantha
authors: S
authors: Moir
authors: Fakhar
authors: F
authors: Khan
authors: Kaisa
authors: K
authors: Maki-Petaja
authors: Emma L
authors: EL
authors: Gayton
authors: Christopher H
authors: CH
authors: Strey
authors: Samuel
authors: S
authors: O'Toole
authors: Shaumya
authors: S
authors: Ariyaratnam
authors: David J
authors: DJ
authors: Halsall
authors: Afzal N
authors: AN
authors: Chaudhry
authors: Laurence
authors: L
authors: Berman
authors: Daniel J
authors: DJ
authors: Scoffings
authors: Nagui M
authors: NM
authors: Antoun
authors: David P
authors: DP
authors: Dutka
authors: Ian B
authors: IB
authors: Wilkinson
authors: John M
authors: JM
authors: Shneerson
authors: John D
authors: JD
authors: Pickard
authors: Helen L
authors: HL
authors: Simpson
authors: Mark
authors: M
authors: Gurnell
mesh_terms: D000172:Acromegaly / Q000150:complications / Q000188:drug therapy* / Q000601:surgery; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage; D005260:Female; D019382:Human Growth Hormone / Q000097:blood; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000209:etiology; D017379:Hypertrophy, Left Ventricular / Q000188:drug therapy* / Q000209:etiology; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010456:Peptides, Cyclic / Q000008:administration & dosage*; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D017481:Receptors, Somatostatin / Q000037:antagonists & inhibitors; D012891:Sleep Apnea Syndromes / Q000188:drug therapy* / Q000209:etiology; D013004:Somatostatin / Q000008:administration & dosage / Q000031:analogs & derivatives*; D016896:Treatment Outcome; D059289:Vascular Stiffness / Q000187:drug effects; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D010456:Peptides, Cyclic; D017481:Receptors, Somatostatin; C060347:lanreotide; D019382:Human Growth Hormone; D013004:Somatostatin; D007334:Insulin-Like Growth Factor I