Risk factors for glucose intolerance in active acromegaly

Abstract

In the present retrospective study we determined the frequency of glucose intolerance in active untreated acromegaly, and searched for risk factors possibly supporting the emergence of the diabetic condition. Among 43 patients, 8 (19%; 95% CI: 8-33%) had diabetes mellitus and 2 (5%; 1-16%) impaired glucose tolerance. No impaired fasting glycemia was demonstrable. The frequency of diabetes was on average 4.5 times higher than in the general Slovak population. Ten factors suspected to support progression to glucose intolerance were studied by comparing the frequency of glucose intolerance between patients with present and absent risk factors. A family history of diabetes and arterial hypertension proved to have a significant promoting effect (P<0.05, chi-square test). A significant association with female gender was demonstrated only after pooling our data with literature data. Concomitant prolactin hypersecretion had a nonsignificant promoting effect. In conclusion, the association of active untreated acromegaly with each of the three categories of glucose intolerance (including impaired fasting glycemia, not yet studied in this connection) was defined as a confidence interval, thus permitting a sound comparison with the findings of future studies. Besides a family history of diabetes, female gender and arterial hypertension were defined as additional, not yet described risk factors.

Therapy of acromegalic patients exacerbated by concomitant type 2 diabetes requires higher pegvisomant doses to normalise IGF1 levels

“…Rather depending on the genetic predisposition of individual patients than on the manifestation of acromegaly, insulin resistance leads to alterations in glucose metabolism, e.g. to a pathological glucose tolerance or manifest diabetes (4,5). Patients without the risk of developing diabetes mellitus obviously can compensate the diminished insulin sensitivitycaused by elevated GH levels -through increased insulin secretion.…”

“…However, concurrent manifestation of acromegaly and diabetes mellitus does not represent a particularly high activity of acromegaly, but depends on the genetic predisposition of the affected patients (4,5).…”

Diabetes mellitusin a cohort of patients with acromegaly

“…I mpaired glucose tolerance (IGT) or overt diabetes mellitus (DM) are well-recognized comorbidities in patients with acromegaly (1,2), and found in up to 50% of cases at diagnosis (1,3). The abnormality responsible for the presence of diabetes and IGT include hepatic and peripheral insulin resistance, as well as increased hepatic glucose production (1,2,4).…”

“…The prevalence of glucose intolerance in acromegaly has been shown to correlate with GH levels, age, disease duration, and family history for diabetes (3). Therefore, all these are confounding factors, should be taken into account when patients with acromegaly and diabetes are evaluated.…”

Ketoacidosis as the initial clinical condition in nine patients with acromegaly: a review of 860 cases at a single institute

“…Thus, patients with acromegaly are predisposed to developing diabetes mellitus (DM) in addition to skeletal complications and cardiovascular and respiratory diseases (3). Risk factors for impaired glucose metabolism include high serum levels of GH, older age, longer duration of the disease, family history of DM, and concomitant hypertension (4,5,6). The prevalence of diabetes among patients with acromegaly has been reported to range from 19 to 56% (3).…”