Dogansen Sema Ciftci, Yalin Gulsah Yenidunya, Tanrikulu Seher, Yarman Sema
Istanbul University, Istanbul Faculty of Medicine, Division of Endocrinology and Metabolism, Istanbul, Turkey.
Horm Metab Res. 2018 May;50(5):408-413. doi: 10.1055/a-0594-2404. Epub 2018 Apr 11.
In this study, we aimed to evaluate the presence of glucose metabolism abnormalities and their impact on IGF-1 levels in patients with acromegaly. Ninety-three patients with acromegaly (n=93; 52 males/41 females) were included in this study. Patients were separated into three groups such as; normal glucose tolerance (n=23, 25%), prediabetes (n=38, 41%), and diabetes mellitus (n=32, 34%). Insulin resistance was calculated with homeostasis model assessment (HOMA). HOMA-IR > 2.5 or ≤2.5 were defined as insulin resistant or noninsulin resistant groups, respectively. Groups were compared in terms of factors that may be associated with glucose metabolism abnormalities. IGF-1% ULN (upper limit of normal)/GH ratios were used to evaluate the impact of glucose metabolism abnormalities on IGF-1 levels. Patients with diabetes mellitus were significantly older with an increased frequency of hypertension (p<0.001, p=0.01, respectively). IGF-1% ULN/GH ratio was significantly lower in prediabetes group than in normal glucose tolerance group (p=0.04). Similarly IGF-1% ULN/GH ratio was significantly lower in insulin resistant group than in noninsulin resistant group (p=0.04). Baseline and suppressed GH levels were significantly higher in insulin resistant group than in noninsulin resistant group (p=0.024, p<0.001, respectively). IGF-1% ULN/GH ratio is a useful marker indicating glucose metabolism disorders and IGF-1 levels might be inappropriately lower in acromegalic patients with insulin resistance or prediabetes. We suggest that IGF-1 levels should be re-evaluated after the improvement of insulin resistance or glycemic regulation for the successful management of patients with acromegaly.
在本研究中，我们旨在评估肢端肥大症患者葡萄糖代谢异常的存在情况及其对胰岛素样生长因子-1（IGF-1）水平的影响。本研究纳入了93例肢端肥大症患者（n = 93；52例男性/41例女性）。患者被分为三组，即：正常糖耐量（n = 23，25%）、糖尿病前期（n = 38，41%）和糖尿病（n = 32，34%）。采用稳态模型评估（HOMA）计算胰岛素抵抗。HOMA-IR＞2.5或≤2.5分别定义为胰岛素抵抗组或非胰岛素抵抗组。比较各组可能与葡萄糖代谢异常相关的因素。使用IGF-1%正常上限（ULN）/生长激素（GH）比值评估葡萄糖代谢异常对IGF-1水平的影响。糖尿病患者年龄显著更大，高血压发生率增加（分别为p＜0.001，p = 0.01）。糖尿病前期组的IGF-1% ULN/GH比值显著低于正常糖耐量组（p = 0.04）。同样，胰岛素抵抗组的IGF-1% ULN/GH比值显著低于非胰岛素抵抗组（p = 0.04）。胰岛素抵抗组的基线和抑制后GH水平显著高于非胰岛素抵抗组（分别为p = 0.024，p＜0.001）。IGF-1% ULN/GH比值是提示葡萄糖代谢紊乱的有用标志物，在伴有胰岛素抵抗或糖尿病前期的肢端肥大症患者中，IGF-1水平可能会不恰当地降低。我们建议，为成功治疗肢端肥大症患者，在胰岛素抵抗或血糖调节改善后应重新评估IGF-1水平。
