title: Prospective study of surgical treatment of acromegaly: effects on ghrelin, weight, adiposity, and markers of CV risk.
abstract: BACKGROUND
  Although epidemiological studies have found that GH and IGF-1 normalization reduce the excess mortality of active acromegaly to expected rates, cross-sectional data report some cardiovascular (CV) risk markers to be less favorable in remission than active acromegaly.
  
  
  OBJECTIVE
  The objective of the study was to test the hypothesis that remission of acromegaly after surgical therapy increases weight and adiposity and some CV risk markers and these changes are paralleled by a rise in ghrelin.
  
  
  METHODS
  Forty-two adults with untreated, active acromegaly were studied prospectively. Changes in outcome measures from before to after surgery were assessed in 26 subjects achieving remission (normal IGF-1) and 16 with persistent active acromegaly (elevated IGF-1) after surgery.
  
  
  METHODS
  The study was conducted at tertiary referral centers for pituitary tumors.
  
  
  METHODS
  Endocrine, metabolic, and CV risk parameters, anthropometrics, and body composition by dual-energy X-ray absorptiometry were measured.
  
  
  RESULTS
  Remission increased total ghrelin, body weight, waist circumference, C-reactive protein, homocysteine, high-density lipoprotein, and leptin and reduced systolic blood pressure, homeostasis model assessment score, triglycerides, and lipoprotein (a) by 6 months and for 32 ± 4 months after surgery. The ghrelin rise correlated with the fall in the levels of GH, IGF-1, and insulin and insulin resistance. Weight, waist circumference, and ghrelin did not increase significantly in the persistent active acromegaly group. Total body fat, trunk fat, and perentage total body fat increased by 1 year after surgery in 15 remission subjects: the increase in body fat correlated with the rise in total ghrelin.
  
  
  CONCLUSIONS
  Although most markers of CV risk improve with acromegaly remission after surgery, some markers and adiposity increase and are paralleled by a rise in total ghrelin, suggesting that these changes may be related. Understanding the mechanisms and long-term implications of the changes that accompany treatment of acromegaly is important to optimizing management because some aspects of the postoperative profile associate with the increased metabolic and CV risk in other populations.
authors.affiliation: Departments of Medicine (C.R-V., J.C.F., I.M.C., P.U.F.) and Neurosurgery (J.N.B.), Columbia University College of Physicians and Surgeons, New York, New York 10032; Department of Neurosurgery (C.C.), Rutgers New Jersey Medical School, Rutgers, New Jersey 07103; and Departments of Neurosurgery (J.K., E.B.G., K.D.P.) and Medicine (E.B.G., K.D.P.), Mt Sinai Medical Center, New York, New York 10029.
authors.forename: Carlos
authors.initials: C
authors.lastname: Reyes-Vidal
authors.forename: Jean Carlos
authors.initials: JC
authors.lastname: Fernandez
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Bruce
authors.forename: Celina
authors.initials: C
authors.lastname: Crisman
authors.forename: Irene M
authors.initials: IM
authors.lastname: Conwell
authors.forename: Jane
authors.initials: J
authors.lastname: Kostadinov
authors.forename: Eliza B
authors.initials: EB
authors.lastname: Geer
authors.forename: Kalmon D
authors.initials: KD
authors.lastname: Post
authors.forename: Pamela U
authors.initials: PU
authors.lastname: Freda
mesh_terms: D000172:Acromegaly / Q000150:complications / Q000378:metabolism / Q000601:surgery*; D000236:Adenoma / Q000150:complications / Q000378:metabolism / Q000601:surgery; D050154:Adiposity / Q000502:physiology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure / Q000502:physiology; D001835:Body Weight / Q000502:physiology*; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000378:metabolism; D005260:Female; D054439:Ghrelin / Q000097:blood*; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology; D007334:Insulin-Like Growth Factor I / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000150:complications / Q000378:metabolism / Q000601:surgery; D011446:Prospective Studies; D012306:Risk; D016896:Treatment Outcome; D055105:Waist Circumference / Q000502:physiology; D055815:Young Adult
chemical_list: D015415:Biomarkers; D054439:Ghrelin; D007334:Insulin-Like Growth Factor I