Gender dimorphism in body composition abnormalities in acromegaly: males are more affected than females

Abstract

Background: Acromegaly changes body composition (BC), but long-term gender differences have not been reported. Objective: To evaluate BC in active and controlled acromegalic patients. Design and methods: Clinical and biochemical variables and BC (by dual-energy X-ray absorptiometry) were evaluated in 60 acromegalic patients (19 active, 41 controlled) and 105 controls, matched for age and gender. Results: Acromegalic males (nZ24) had more total mass (89G13 vs 76.5G15.3 kg, P!0.001), lean body mass (LBM; 64.6G8.7 vs 56.4G5.8 kg, P!0.001), and bone mineral content (BMC; 2.9G0.5 vs 2.6G0.3 kg, P!0.05) than controls (nZ33). Controlled male patients (nZ14) had more total mass (89G14.7 vs 76.5G15.3 kg, P!0.05) and a trend to have more LBM (61.8G9.4 vs 56.4G5.8 kg, PZ0.065) than controls. Only in active disease was a decrease in fat mass (FM) observed, compared with controlled patients and controls (males: 19.5G5.3 vs 27G6.2 and 25.9G4%, P!0.001; females: 30.3G 6.7 vs 37.1G5.8 and 36.5G6.6%, P!0.01). In females, no further differences were observed. No differences in BMC were found between eugonadal and hypogonadal acromegalic patients, but in hypogonadal females, acromegaly appeared to prevent the BMC loss seen in hypogonadal postmenopausal controls. GH and IGF1 levels were negatively correlated with FM (males, P!0.05; females, P!0.001), but in the regression analysis GH was a predictor of FM only in women. Conclusions: Control of acromegaly reverts decreased FM in both genders; only in males more total mass and a trend for more LBM persist. The anabolic effect of GH on bone reverted in cured males, but persisted in females and appeared to override the bone loss of menopause.

IGF-1 levels across the spectrum of normal to elevated in acromegaly: relationship to insulin sensitivity, markers of cardiovascular risk and body composition

“…We further these findings and show that %ULN IGF-1 is a negative predictor of fat mass and % fat and that % ULN IGF-1 levels are a stronger predictor than GH levels of body composition changes in acromegaly. By contrast, in another study of 60 subjects (20 on medical therapy), GH predicted fat mass better than IGF-1 (26) and in another IGF-1 levels did not correlate with fat mass determined by cross-sectional CT (27). In our study, as in the general population, % body and trunk fat are higher in women than men with acromegaly, and after accounting for fat mass and other variables, gender along with %ULN IGF-1 remain significant predictors of % fat.…”

Reduction of trabecular and cortical volumetric bone mineral density at the proximal femur in patients with acromegaly

“…Yet, we did not find any relationship between the gonadal status and trabecular vBMD at any sites of the proximal femur. Indeed, after multiple linear regressions, duration of active acromegaly was the only negative predictor of trabecular vBMD at TH and IT, suggesting that chronic exposure to GH/IGF1 negatively impacts the trabecular bone at the level of the proximal femur, counteracting the effect of the gonadal status (14,21). No differences in trabecular vBMD were documented in controlled ACRO patients when compared to either active ACRO or healthy subjects, suggesting that the biochemical control of the disease leads to an improvement, but not normalization, of the trabecular compartment.…”

Effects of GH-IGF-I excess and gonadal status on bone mineral density and body composition in patients with acromegaly

“…The same study found higher BMD at the spine, femur, and forearm areas compared to controls. Sucunza et al [12] evaluated 60 patients and 105 controls and found a decrease in fat mass in active acromegaly, reversible after disease control; lean mass was irreversibly increased only in men.…”

“…The majority of authors describe an increase in lean mass and a decrease in fat mass of acromegalic patients [10][11][12][13]. However, data on bone mineral density (BMD) in these patients are still conflicting.…”