Department of Medicine, University Health Network, Toronto, Ontario, Canada.
PLoS One. 2013 Sep 9;8(9):e73543. doi: 10.1371/journal.pone.0073543. eCollection 2013.
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.
Clinical presentation, pituitary tumor size and invasiveness, and pituitary pathology were captured in a dedicated database.
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.
Patients with pure somatotroph adenomas are more likely than those with mixed adenomas to exhibit abnormal glucose metabolism.
肢端肥大症常伴有葡萄糖耐量受损和/或糖尿病。为了评估葡萄糖代谢与肢端肥大症之间的关系，我们评估了来自两个转诊中心的 269 例连续患者。
在专门的数据库中记录了临床表现、垂体肿瘤大小和侵袭性以及垂体病理。
共纳入 131 名女性和 138 名男性患者，平均年龄为 53.8 岁。其中 201 例（74.7%）为大腺瘤，18 例（6.7%）为微腺瘤。91 例（33.8%）存在影像学侵袭。肿瘤平均直径为 1.86cm（0.2-4.6）。垂体组织病理学检查显示，147 例为单纯 GH 分泌生长激素腺瘤（SA），46 例为混合催乳素（LA）和 SA 或乳生长激素腺瘤（MSA）（22.4%），6 例为嗜酸性干细胞腺瘤（2.9%），6 例为其他诊断（2.9%）。治疗包括奥曲肽 96 例（36.9%），奥曲肽联合培维索孟或多巴胺激动剂 63 例（24.2%）。近 80%的患者 IGF-1 正常化。重要的是，单纯生长激素腺瘤患者发生葡萄糖代谢异常的可能性显著高于混合腺瘤患者[48.7%比 9.7%]（p<0.001），与 GH/IGF-1 水平或肿瘤侵袭性无关。IGF-1 正常化后，葡萄糖代谢异常与垂体病理仍相关。此外，尽管接受了相同的治疗策略，单纯 SA 且葡萄糖代谢异常的患者达到疾病缓解的可能性显著降低（p<0.001）。相反，混合腺瘤患者更有可能（OR：2.766（95%CI：1.490-5.136）达到疾病缓解。
单纯生长激素腺瘤患者比混合腺瘤患者更易出现葡萄糖代谢异常。
