Ferraù Francesco, Albani Adriana, Ciresi Alessandro, Giordano Carla, Cannavò Salvatore
Department of Human Pathology of Adulthood and Childhood 'G. Barresi', University of Messina, Messina, Italy.
Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
Front Endocrinol (Lausanne). 2018 Jul 6;9:358. doi: 10.3389/fendo.2018.00358. eCollection 2018.
Acromegaly is a rare disease due to chronic GH excess and to the consequent increase in IGF-1 levels. Both GH and IGF-1 play a role in intermediate metabolism affecting glucose homeostasis. Indeed, chronic GH excess impairs insulin sensitivity, increases gluconeogenesis, reduces the glucose uptake in adipose tissue and muscle and alters pancreatic β cells function. As a consequence, glucose metabolism alterations are a very frequent complication in acromegaly patients, further contributing to the increased cardiovascular risk and mortality. Treatment modalities of acromegaly differently impact on glucose tolerance. Successful surgical treatment of acromegaly ameliorates glucose metabolism abnormalities. Drugs used to treat acromegaly patients may affect glucose homeostasis, therefore influencing patients' management. Indeed pegvisomant has been shown to positively impact on glucose metabolism, while somatostatin analogs, especially pasireotide, can cause hyperglycaemia. On the other hand, robust data on the effect of dopamine agonists on glycaemic profile are still lacking. This review summarizes the available data on diabetes mellitus in acromegaly patients, with a focus on the potential effects of the medical treatment of the disease on glucose homeostasis, providing an overview of the current state of the art.
肢端肥大症是一种罕见疾病，由于长期生长激素（GH）分泌过多以及随之而来的胰岛素样生长因子-1（IGF-1）水平升高所致。GH和IGF-1均在中间代谢中发挥作用，影响葡萄糖稳态。实际上，长期GH分泌过多会损害胰岛素敏感性，增加糖异生，减少脂肪组织和肌肉对葡萄糖的摄取，并改变胰腺β细胞功能。因此，葡萄糖代谢改变是肢端肥大症患者非常常见的并发症，进一步增加了心血管疾病风险和死亡率。肢端肥大症的治疗方式对葡萄糖耐量有不同影响。成功的肢端肥大症手术治疗可改善葡萄糖代谢异常。用于治疗肢端肥大症患者的药物可能会影响葡萄糖稳态，从而影响患者的管理。事实上，培维索孟已被证明对葡萄糖代谢有积极影响，而生长抑素类似物，尤其是帕瑞肽，可导致高血糖。另一方面，关于多巴胺激动剂对血糖谱影响的有力数据仍然缺乏。本综述总结了肢端肥大症患者糖尿病的现有数据，重点关注该疾病药物治疗对葡萄糖稳态的潜在影响，概述了当前的技术水平。
