title: Metabolic glucose status and pituitary pathology portend therapeutic outcomes in acromegaly.
abstract: BACKGROUND
  Acromegaly is frequently associated with impaired glucose tolerance and/or diabetes. To evaluate the relationship between glucose metabolism and acromegaly disease, we evaluated 269 consecutive patients from two referral centres.
  
  
  METHODS
  Clinical presentation, pituitary tumor size and invasiveness, and pituitary pathology were captured in a dedicated database.
  
  
  RESULTS
  131 women and 138 men with a mean age of 53.8 years were included. Of these, 201 (74.7%) presented with a macroadenoma and 18 (6.7%) with a microadenoma. Radiographic invasion was present in 91 cases (33.8%). Mean tumor diameter was 1.86 cm (0.2-4.6). Pituitary histopathologic findings revealed pure GH-producing somatotroph adenomas (SA) in 147 patients, prolactin-production by mixed lactotroph (LA) and SA or mammosomatotroph adenoma (MSA) in 46 [22.4%], acidophil stem cell adenoma in 6 [2.9%], and other diagnoses in 6 [2.9%]. Medical treatment included octreotide in 96 [36.9%] and in combination with pegvisomant or dopamine agonists in 63 [24.2%]. Nearly 80% of patients achieved IGF-1 normalization. Importantly, patients with pure somatotroph adenomas were significantly more likely to present with abnormal glucose metabolism [48.7%] than those with mixed adenomas [9.7%] [p<0.001] independent of GH/IGF-1 levels or tumor invasiveness. Abnormal glucose metabolism and pituitary pathology also remained linked following IGF-1 normalization. Moreover patients with pure SA and abnormal glucose metabolism were significantly (p<0.001) less likely to achieve disease remission despite the same therapeutic strategies. Conversely, patients with mixed adenomas were more likely (OR: 2.766 (95% CI: 1.490-5.136) to achieve disease remission.
  
  
  CONCLUSIONS
  Patients with pure somatotroph adenomas are more likely than those with mixed adenomas to exhibit abnormal glucose metabolism.
authors.affiliation: Department of Medicine, University Health Network, Toronto, Ontario, Canada.
authors.forename: Sonia
authors.initials: S
authors.lastname: Cheng
authors.forename: Rany
authors.initials: R
authors.lastname: Al-Agha
authors.forename: Paula B
authors.initials: PB
authors.lastname: Araujo
authors.forename: Omar
authors.initials: O
authors.lastname: Serri
authors.forename: Sylvia
authors.initials: S
authors.lastname: L Asa
authors.forename: Shereen
authors.initials: S
authors.lastname: Ezzat
mesh_terms: D000172:Acromegaly / Q000150:complications / Q000378:metabolism* / Q000473:pathology* / Q000628:therapy; D000236:Adenoma / Q000150:complications / Q000378:metabolism* / Q000473:pathology / Q000628:therapy; D005260:Female; D005947:Glucose / Q000378:metabolism*; D013006:Growth Hormone / Q000378:metabolism; D049912:Growth Hormone-Secreting Pituitary Adenoma / Q000150:complications / Q000378:metabolism* / Q000473:pathology / Q000628:therapy; D019382:Human Growth Hormone / Q000031:analogs & derivatives / Q000378:metabolism; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010902:Pituitary Gland / Q000378:metabolism / Q000473:pathology*; D010911:Pituitary Neoplasms / Q000150:complications / Q000378:metabolism / Q000473:pathology / Q000628:therapy
chemical_list: D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I; D013006:Growth Hormone; D005947:Glucose; C406545:pegvisomant
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