Bredella Miriam A, Schorr Melanie, Dichtel Laura E, Gerweck Anu V, Young Brian J, Woodmansee Whitney W, Swearingen Brooke, Miller Karen K
Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114.
Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114.
J Clin Endocrinol Metab. 2017 Nov 1;102(11):4218-4225. doi: 10.1210/jc.2017-01210.
Acromegaly is characterized by growth hormone (GH) and insulinlike growth factor-1 (IGF-1) hypersecretion, and GH and IGF-1 play important roles in regulating body composition and glucose homeostasis.
The purpose of our study was to investigate body composition including ectopic lipids, measures of glucose homeostasis, and gonadal steroids in patients with active acromegaly compared with age-, body mass index (BMI)-, and sex-matched controls and to determine changes in these parameters after biochemical control of acromegaly.
Cross-sectional study of 20 patients with active acromegaly and 20 healthy matched controls. Prospective study of 16 patients before and after biochemical control of acromegaly.
Body composition including ectopic lipids by magnetic resonance imaging/proton magnetic resonance spectroscopy; measures of glucose homeostasis by an oral glucose tolerance test; gonadal steroids.
Patients with active acromegaly had lower mean intrahepatic lipid (IHL) and higher mean fasting insulin and insulin area under the curve (AUC) values than controls. Men with acromegaly had lower mean total testosterone, sex hormone-binding globulin, and estradiol values than male controls. After therapy, homeostasis model assessment of insulin resistance, fasting insulin level, and insulin AUC decreased despite an increase in IHL and abdominal and thigh adipose tissues and a decrease in muscle mass.
Patients with acromegaly were characterized by insulin resistance and hyperinsulinemia but lower IHL compared with age-, BMI-, and sex-matched healthy controls. Biochemical control of acromegaly improved insulin resistance but led to a less favorable anthropometric phenotype with increased IHL and abdominal adiposity and decreased muscle mass.
肢端肥大症的特征是生长激素（GH）和胰岛素样生长因子-1（IGF-1）分泌过多，而GH和IGF-1在调节身体成分和葡萄糖稳态中起重要作用。
我们研究的目的是调查活动期肢端肥大症患者的身体成分（包括异位脂质）、葡萄糖稳态指标和性腺类固醇，并与年龄、体重指数（BMI）和性别匹配的对照组进行比较，同时确定肢端肥大症生化指标得到控制后这些参数的变化。
对20例活动期肢端肥大症患者和20例健康匹配对照进行横断面研究。对16例肢端肥大症患者在生化指标控制前后进行前瞻性研究。
通过磁共振成像/质子磁共振波谱测定包括异位脂质在内的身体成分；通过口服葡萄糖耐量试验测定葡萄糖稳态指标；测定性腺类固醇。
活动期肢端肥大症患者的平均肝内脂质（IHL）低于对照组，平均空腹胰岛素和胰岛素曲线下面积（AUC）值高于对照组。患肢端肥大症的男性的平均总睾酮、性激素结合球蛋白和雌二醇值低于男性对照组。治疗后，尽管IHL、腹部和大腿脂肪组织增加，肌肉量减少，但胰岛素抵抗的稳态模型评估、空腹胰岛素水平和胰岛素AUC均下降。
与年龄、BMI和性别匹配的健康对照组相比，肢端肥大症患者具有胰岛素抵抗和高胰岛素血症，但IHL较低。肢端肥大症的生化指标控制改善了胰岛素抵抗，但导致了人体测量学表型变差，IHL和腹部脂肪增加，肌肉量减少。
