Department of Endocrinology, Postgraduate Institute Medical Education and Research (PGIMER), Chandigarh, India.
Department of Neurosurgery, Postgraduate Institute Medical Education and Research (PGIMER), Chandigarh, India.
Neurol India. 2019 May-Jun;67(3):757-762. doi: 10.4103/0028-3886.263242.
The natural history of glucose intolerance (GI) in patients with acromegaly undergoing surgical treatment has not been fully understood. This study was aimed to unravel the prevalence and predictors of recovery from GI in these patients in a prospective multivariate model.
Patients with acromegaly treated between 2007 and 2016 were prospectively studied with respect to demographics, clinicoradiological features, comorbidities, and hormonal investigations before surgery and at regular follow-up. The independent predictors of recovery from diabetes were analyzed.
There were a total of 151 patients with active acromegaly included in the study. The median baseline growth hormone (GH) and insulin-like growth factor (IGF)-1 levels were 25 and 811 ng/mL, respectively. Diabetes mellitus (DM) and pre-diabetes were noted in 93 (61.6%) and 20 (13.2%) patients, respectively. Following surgical treatment, the median HbA1c decreased significantly from 6.4% to 5.5% (P < 0.001), with 46.8% having complete recovery from DM or pre-diabetes. This glycemic recovery had significant association with both biochemical (P = 0.001) and radiological remission (P = 0.01). The recovery from DM had a greater association with post-operative IGF-1 than GH, especially among those with discordant GH and IGF-1 levels (60% in normal IGF-1 and high GH vs. 20% in high IGF-1 and normal GH). Post-operative IGF-1 had a significant impact on recovery from DM (P = 0.01) independent of age, body mass index, duration of DM, and pre-operative HbA1c.
Nearly half of the patients with acromegaly with DM or pre-diabetes had glycemic recovery, influenced by biochemical and radiologic remission. Post-operative IGF-1 appears to be the strongest independent determinant of recovery from DM.
接受手术治疗的肢端肥大症患者葡萄糖耐量（GI）异常的自然病程尚未完全阐明。本研究旨在建立一个前瞻性多变量模型，以揭示这些患者 GI 恢复的发生率和预测因素。
前瞻性研究了 2007 年至 2016 年间接受治疗的肢端肥大症患者的人口统计学、临床影像学特征、合并症以及手术前后的激素检查。分析了恢复糖尿病的独立预测因素。
共纳入 151 例活动性肢端肥大症患者。基线时生长激素（GH）和胰岛素样生长因子 1（IGF-1）水平中位数分别为 25ng/ml 和 811ng/ml。93 例（61.6%）和 20 例（13.2%）患者分别患有糖尿病和糖尿病前期。经手术治疗后，HbA1c 中位数从 6.4%显著降低至 5.5%（P＜0.001），46.8%患者完全恢复正常血糖，无糖尿病或糖尿病前期。这种血糖恢复与生化缓解（P=0.001）和影像学缓解（P=0.01）均显著相关。恢复正常血糖与术后 IGF-1 关系更为密切，与 GH 关系相对较小，特别是 GH 和 IGF-1 水平不一致的患者（正常 IGF-1 和高 GH 患者中 60%恢复正常血糖，高 IGF-1 和正常 GH 患者中 20%恢复正常血糖）。术后 IGF-1 对恢复正常血糖有显著影响（P=0.01），独立于年龄、体重指数、糖尿病病程和术前 HbA1c。
近一半的肢端肥大症合并糖尿病或糖尿病前期的患者存在血糖恢复，受生化和影像学缓解的影响。术后 IGF-1 似乎是恢复正常血糖的最强独立决定因素。
