Department of Endocrinology and Metabolism, University of Pisa, Ospedale Cisanello, Via Paradisa 2, 56124 Pisa, Italy.
Eur J Endocrinol. 2013 Jun 7;169(1):99-108. doi: 10.1530/EJE-13-0032. Print 2013 Jul.
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.
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.
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.
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.
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.
葡萄糖代谢异常是肢端肥大症的常见表现。然而，关于生长抑素类似物（SSA）或培维索孟（PEG）治疗是否会对葡萄糖代谢产生不同影响，目前还缺乏有力的证据。本研究的目的是评估在一系列肢端肥大症患者中，SSA、PEG 或两者联合治疗对葡萄糖代谢的影响。
这是一项历史前瞻性研究。在 50 例连续接受 SSA 治疗的肢端肥大症患者中，19 例患者的肢端肥大症得到控制。SSA 联合 PEG 治疗可使其余 31 例患者的肢端肥大症得到控制，随后 18 例患者继续接受 PEG 单药治疗。
在诊断肢端肥大症时和不同治疗期间评估以下参数：空腹血糖（FPG）和胰岛素浓度、胰岛素敏感性（QUICK-I）、稳态模型评估的胰岛素抵抗（HOMA2-IR）以及口服葡萄糖耐量试验（OGTT）期间的血糖和胰岛素浓度。采用配对数据的分析方法进行比较。
使用 SSA、PEG 或 SSA+PEG 治疗控制肢端肥大症时，胰岛素抵抗得到改善。然而，与疾病活动相关时，与诊断时相比，SSA 治疗（单独或联合使用 PEG）时 FPG 浓度更高，而在 PEG 治疗时则更低。接受 SSA 治疗的患者在 OGTT 期间的平均血糖浓度高于接受 PEG 治疗的患者。此外，与诊断时或 PEG 治疗时相比，接受 SSA 治疗时糖尿病或糖耐量受损的患病率更高，且不受疾病控制的影响。
肢端肥大症的药物治疗可降低胰岛素抵抗并提高胰岛素敏感性；相反，SSA 或 PEG 治疗可能会对葡萄糖指标产生不同的影响。
