title: Effects of medical therapies for acromegaly on glucose metabolism.
abstract: OBJECTIVE
  Abnormalities of glucose metabolism are common findings of acromegaly. However, robust evidence on whether therapy with somatostatin analogs (SSAs) or pegvisomant (PEG) differently affects glucose metabolism is lacking. The purpose of this study was to evaluate the effects of therapy with SSAs, PEG, or their combination on glucose metabolism in a large series of acromegalic patients.
  
  
  METHODS
  This was a historical-prospective study. Among 50 consecutive acromegalic patients under SSA therapy, acromegaly in 19 patients was controlled. PEG used in combination with SSA therapy allowed the control of acromegaly in the remaining 31 patients and was then continued as monotherapy in 18 patients.
  
  
  METHODS
  The following parameters were evaluated at the diagnosis of acromegaly and during DIFFERENT TREATMENTS: fasting plasma glucose (FPG) and insulin concentrations, insulin sensitivity (QUICK-I), homeostasis model assessment of insulin resistance (HOMA2-IR), and plasma glucose and insulin concentrations during the oral glucose tolerance test (OGTT). Comparison was made using analysis for paired data.
  
  
  RESULTS
  Insulin resistance improved when acromegaly was controlled with therapy with SSAs, PEG, or SSA+PEG. However, FPG concentrations were higher during SSA therapy (alone or combined with PEG) than at the diagnosis of acromegaly, even when corrected for disease activity, whereas they were reduced during PEG therapy. Mean glucose concentrations during the OGTT were higher in patients receiving SSA therapy than in those receiving PEG therapy. In addition, the prevalence of diabetes or impaired glucose tolerance was higher during SSA therapy than at diagnosis or during PEG therapy and was not influenced by disease control.
  
  
  CONCLUSIONS
  Medical therapies for acromegaly reduce insulin resistance and increase insulin sensitivity; on the contrary, glucose indexes may be differently affected by SSA or PEG therapy.
authors: Department of Endocrinology and Metabolism, University of Pisa, Ospedale Cisanello, Via Paradisa 2, 56124 Pisa, Italy.
authors: C
authors: C
authors: Urbani
authors: C
authors: C
authors: Sardella
authors: A
authors: A
authors: Calevro
authors: G
authors: G
authors: Rossi
authors: I
authors: I
authors: Scattina
authors: M
authors: M
authors: Lombardi
authors: I
authors: I
authors: Lupi
authors: L
authors: L
authors: Manetti
authors: E
authors: E
authors: Martino
authors: F
authors: F
authors: Bogazzi
mesh_terms: D000172:Acromegaly / Q000097:blood* / Q000188:drug therapy* / Q000378:metabolism; D000328:Adult; D000368:Aged; D019540:Area Under Curve; D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism; D004359:Drug Therapy, Combination; D005215:Fasting; D005260:Female; D005951:Glucose Tolerance Test; D006727:Hormone Antagonists / Q000008:administration & dosage / Q000494:pharmacology*; D019382:Human Growth Hormone / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000494:pharmacology; D006801:Humans; D007328:Insulin / Q000097:blood*; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011986:Receptors, Somatotropin / Q000037:antagonists & inhibitors*; D012189:Retrospective Studies; D013004:Somatostatin / Q000008:administration & dosage / Q000009:adverse effects* / Q000031:analogs & derivatives
chemical_list: D001786:Blood Glucose; D006727:Hormone Antagonists; D007328:Insulin; D011986:Receptors, Somatotropin; D019382:Human Growth Hormone; D013004:Somatostatin; C406545:pegvisomant