title: Preoperative octreotide therapy and surgery in acromegaly: associations between glucose homeostasis and treatment response.
abstract: In acromegaly, high GH/IGF-1 levels associate with abnormal glucose metabolism. Somatostatin analogs (SSAs) reduce GH and IGF-1 but inhibit insulin secretion. We studied glucose homeostasis in de novo patients with acromegaly and changes in glucose metabolism after treatment with SSA and surgery. In this post hoc analysis from a randomized controlled trial, 55 de novo patients with acromegaly, not using antidiabetic medication, were included. Before surgery, 26 patients received SSAs for 6 months. HbA1c, fasting glucose, and oral glucose tolerance test were performed at baseline, after SSA pretreatment and at 3 months postoperative. Area under curve of glucose (AUC-G) was calculated. Glucose homeostasis was compared to baseline levels of GH and IGF-1, change after SSA pretreatment, and remission both after SSA pretreatment and 3 months postoperative. In de novo patients, IGF-1/GH levels did not associate with baseline glucose parameters. After SSA pretreatment, changes in GH/IGF-1 correlated positively to change in HbA1c levels (both p < 0.03). HbA1c, fasting glucose, and AUC-G increased significantly during SSA pretreatment in patients not achieving hormonal control (all p < 0.05) but did not change significantly in patients with normalized hormone levels. At 3 months postoperative, HbA1c, fasting glucose, and AUC-G were significantly reduced in both cured and not cured patients (all p < 0.05). To conclude, in de novo patients with acromegaly, disease activity did not correlate with glucose homeostasis. Surgical treatment of acromegaly improved glucose metabolism in both cured and not cured patients, while SSA pretreatment led to deterioration in glucose homeostasis in patients not achieving biochemical control.
authors.affiliation: Department of Internal Medicine, Drammen Hospital, Vestre Viken, Drammen, Norway.
authors.forename: R
authors.initials: R
authors.lastname: Helseth
authors.affiliation: Department of Endocrinology, Medical Clinic, St. Olavs University Hospital, 7006, Trondheim, Norway.|Unit for Applied Clinical Research, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
authors.forename: S M
authors.initials: SM
authors.lastname: Carlsen
authors.affiliation: Section of Specialized Endocrinology, Department of Endocrinology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.|Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: J
authors.initials: J
authors.lastname: Bollerslev
authors.affiliation: Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway.|Tromsø Endocrine Research Group, Institute of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
authors.forename: J
authors.initials: J
authors.lastname: Svartberg
authors.affiliation: Department of Medicine and Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway.
authors.forename: M
authors.initials: M
authors.lastname: Øksnes
authors.affiliation: Division of Medicine, Stavanger University Hospital, Stavanger, Norway.
authors.forename: S
authors.initials: S
authors.lastname: Skeie
authors.affiliation: Department of Endocrinology, Medical Clinic, St. Olavs University Hospital, 7006, Trondheim, Norway. stine.fougner@ntnu.no.
authors.forename: S L
authors.initials: SL
authors.lastname: Fougner
mesh_terms: D000172:Acromegaly / Q000097:blood / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D003131:Combined Modality Therapy; D005260:Female; D005951:Glucose Tolerance Test; D006706:Homeostasis; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000627:therapeutic use*; D010911:Pituitary Neoplasms / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D007334:Insulin-Like Growth Factor I; D015282:Octreotide
keywords: Acromegaly; Glucose homeostasis; Medical treatment of acromegaly; Pituitary surgery; Somatostatin analogues