Reyes-Vidal Carlos M, Mojahed Hamed, Shen Wei, Jin Zhezhen, Arias-Mendoza Fernando, Fernandez Jean Carlos, Gallagher Dympna, Bruce Jeffrey N, Post Kalmon D, Freda Pamela U
Departments of Medicine (C.M.R.-V., W.S., J.C.F., D.G., P.U.F.), Radiology (H.M., F.A.-M.), Biostatistics (Z.J.), and Neurosurgery (J.N.B.), Columbia University, College of Physicians & Surgeons, New York, New York 10032; and Departments of Medicine and Neurosurgery (K.D.P.), Mt. Sinai School of Medicine, New York, New York 10029.
J Clin Endocrinol Metab. 2015 Aug;100(8):2946-55. doi: 10.1210/jc.2015-1917. Epub 2015 Jun 2.
GH and IGF-I have important roles in the maintenance of substrate metabolism and body composition. However, when in excess in acromegaly, the lipolytic and insulin antagonistic effects of GH may alter adipose tissue (AT) deposition.
The purpose of this study was to examine the effect of surgery for acromegaly on AT distribution and ectopic lipid deposition in liver and muscle.
This was a prospective study before and up to 2 years after pituitary surgery.
The setting was an academic pituitary center.
Participants were 23 patients with newly diagnosed, untreated acromegaly.
We determined visceral (VAT), subcutaneous (SAT), and intermuscular adipose tissue (IMAT), and skeletal muscle compartments by total-body magnetic resonance imaging, intrahepatic and intramyocellular lipid by proton magnetic resonance spectroscopy, and serum endocrine, metabolic, and cardiovascular risk markers.
VAT and SAT masses were lower than predicted in active acromegaly, but increased after surgery in male and female subjects along with lowering of GH, IGF-I, and insulin resistance. VAT and SAT increased to a greater extent in men than in women. Skeletal muscle mass decreased in men. IMAT was higher in active acromegaly and decreased in women after surgery. Intrahepatic lipid increased, but intramyocellular lipid did not change after surgery.
Acromegaly may present a unique type of lipodystrophy characterized by reduced storage of AT in central depots and a shift of excess lipid to IMAT. After surgery, this pattern partially reverses, but differentially in men and women. These findings have implications for understanding the role of GH in body composition and metabolic risk in acromegaly and other clinical settings of GH use.
生长激素（GH）和胰岛素样生长因子-1（IGF-I）在维持底物代谢和身体组成方面具有重要作用。然而，在肢端肥大症中，当GH过量时，其脂解和胰岛素拮抗作用可能会改变脂肪组织（AT）的沉积。
本研究旨在探讨肢端肥大症手术对AT分布以及肝脏和肌肉中异位脂质沉积的影响。
这是一项垂体手术后长达2年的前瞻性研究。
该研究在一个学术性垂体中心进行。
参与者为23例新诊断、未经治疗的肢端肥大症患者。
我们通过全身磁共振成像确定内脏（VAT）、皮下（SAT）和肌间脂肪组织（IMAT）以及骨骼肌区域，通过质子磁共振波谱测定肝内和肌细胞内脂质，并检测血清内分泌、代谢和心血管风险标志物。
在活动性肢端肥大症中，VAT和SAT质量低于预期，但在男性和女性受试者术后均增加，同时GH、IGF-I和胰岛素抵抗降低。男性的VAT和SAT增加幅度大于女性。男性的骨骼肌质量下降。IMAT在活动性肢端肥大症中较高，女性术后降低。术后肝内脂质增加，但肌细胞内脂质未改变。
肢端肥大症可能呈现一种独特类型的脂肪营养不良，其特征是AT在中央储存部位的储存减少，多余脂质向IMAT转移。手术后，这种模式部分逆转，但在男性和女性中存在差异。这些发现对于理解GH在肢端肥大症及其他使用GH的临床环境中对身体组成和代谢风险的作用具有重要意义。
