title: [Abnormalities of carbohydrate metabolism in acromegaly].
abstract: OBJECTIVE
  Carbohydrate metabolism (CHM) is impaired in over 50% of acromegalic patients. Natural history of acromegaly and treatment modalities may impact in a different way on CHM. We assessed CHM alterations in acromegaly and their relationship with clinical features and treatment options.
  
  
  METHODS
  Retrospective study with 55 patients with acromegaly. Age, sex, body mass index (BMI), tumor size, insulin growth factor type 1 (IGF-1) levels and the presence of impaired fasting glucose (IFG) or diabetes mellitus (DM) were analyzed before and after surgery or medical treatment.
  
  
  RESULTS
  There were 30 men and 25 women. Mean age was 50 ± 17 years and mean BMI was 27.9 ± 3.8 Kg/m(2). Impaired CHM was found in 50.9% (n = 28) (DM in 27% and IFG in 24%). In diabetic patients, we found no differences in age, sex, BMI and IGF-1 levels between IFG/DM and patients without CHM impairment. However, IFG/DM patients had macroadenomas more commonly. In diabetic patients, glycosylated hemoglobin (HbA1c) decreased after surgery from 7.6 to 6.7% and after somatostatin analogues from 7.1 to 6.6%; in patients on pegvisomant we observed a significant reduction of HbA1c: from 9.8 to 5.6% (P < .005). Furthermore, only in the pegvisomant group, insulin and/or oral agents had to be lowered.
  
  
  CONCLUSIONS
  Up to 50% of patients with active acromegaly have CHM impairment which correlates with tumor size. Only pegvisomant is associated with significant improvement in glycemic control and a reduction in hypoglycemic treatment.
authors.affiliation: Servicio de Endocrinología y Nutrición, Hospital Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, España. Electronic address: bbiagetti@vhebron.net.
authors.forename: Betina
authors.initials: B
authors.lastname: Biagetti
authors.forename: Gabriel
authors.initials: G
authors.lastname: Obiols
authors.forename: Silvia
authors.initials: S
authors.lastname: Valladares
authors.forename: Lorena
authors.initials: L
authors.lastname: Arnez
authors.forename: Belén
authors.initials: B
authors.lastname: Dalama
authors.forename: Jordi
authors.initials: J
authors.lastname: Mesa
mesh_terms: D000172:Acromegaly / Q000188:drug therapy / Q000209:etiology / Q000378:metabolism* / Q000601:surgery; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D000077465:Cabergoline; D003131:Combined Modality Therapy; D016371:Cranial Irradiation; D003430:Cross-Sectional Studies; D004873:Ergolines / Q000627:therapeutic use; D005260:Female; D005947:Glucose / Q000378:metabolism; D006442:Glycated Hemoglobin / Q000032:analysis; D049912:Growth Hormone-Secreting Pituitary Adenoma / Q000150:complications / Q000378:metabolism / Q000532:radiotherapy / Q000601:surgery; D019382:Human Growth Hormone / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000209:etiology*; D007016:Hypophysectomy; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000150:complications / Q000378:metabolism / Q000532:radiotherapy / Q000601:surgery; D012189:Retrospective Studies; D013004:Somatostatin / Q000031:analogs & derivatives / Q000627:therapeutic use; D047368:Tumor Burden
chemical_list: D001786:Blood Glucose; D000077465:Cabergoline; D004873:Ergolines; D005947:Glucose; D006442:Glycated Hemoglobin; D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I; D013004:Somatostatin; C406545:pegvisomant
keywords: Acromegalia; Acromegaly; Análogos de la somatostatina; Complicaciones; Complications; Diabetes; Epidemiology; Epidemiología; Pegvisomant; Somatostatin analogues