This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Colao, A. Articles by Lombardi, G. Search for Related Content PubMed PubMed Citation Articles by Colao, A. Articles by Lombardi, G. Pubmed/NCBI databases Gene GEO Profiles HomoloGene UniGene Compound via MeSH Substance via MeSH Related Collections Neuroendocrinology and Pituitary Diabetes and Insulin Endocrine Oncology

The Association of Fasting Insulin Concentrations and Colonic Neoplasms in Acromegaly: A Colonoscopy-Based Study in 210 Patients

Department of Molecular and Clinical Endocrinology and Oncology (A.C., R.P., R.S.A., M.G., G.L.), Section of Endocrinology, University "Federico II" of Naples, 80131 Naples, Italy; Department of Endocrine and Metabolic Sciences and Center of Excellence for Biomedical Research (D.F., F.M.), University of Genova, 5-16126 Genova, Italy; and Division of General Medicine (P.M.), Ospedale San Giuseppe, Istituto Auxologico Italiano, 28921 Verbania, Italy

Address all correspondence and requests for reprints to: Annamaria Colao, M.D., Ph.D., Department of Molecular, Clinical Endocrinology and Oncology, "Federico II" University of Naples, via S. Pansini 5, 80131 Naples, Italy. E-mail colao{at}unina.it.

Context: Hyperinsulinemia is associated with colon carcinoma in the general population. Patients with acromegaly are considered to be at risk for developing colonic lesions and typically have hyperinsulinemia.

Objective: Our objective was to evaluate the role of fasting insulin levels on the prevalence of colonic adenomatous polyps or adenocarcinoma in acromegaly.

Design: This is an analytical, observational, prospective study.

Patients: A total of 210 patients (111 women, 99 men, age 20–82 yr) undergoing complete colonoscopy at diagnosis of acromegaly were included in this study.

Results: Colonic lesions were found in 81 patients (38.6%), and consisted of hyperplastic polyps in 33 (15.7%), adenomatous polyps in 42 (20.0%), and adenocarcinoma in six patients (2.8%). Polyps were single in 22 cases (27.1%). Fasting insulin levels were significantly lower in patients without lesions (16.0 ± 7.5 mU/liter) than in patients with hyperplastic polyps (22.4 ± 8.8 mU/liter; P < 0.01), adenomatous polyps (38.0 ± 15.9 mU/liter; P < 0.0001), and adenocarcinoma (59.0 ± 30.6 mU/liter; P < 0.0001). Fasting insulin levels were also lower in patients with hyperplastic polyps than in those with adenomatous polyps (P < 0.01). The odds ratio for harboring colonic adenomas was 14.8 (95% confidence interval 4.4–51.2; P < 0.0001) and 8.6 times higher (95% confidence interval 2.8–29.0; P < 0.0001) in patients with fasting insulin levels in the upper tertile [27.1 mIU/liter (n = 28)] compared with the lower [12.1 mIU/liter (n = 40)] and middle tertiles [>12.1 to <27.1 mIU/liter (n = 74)], respectively.

Conclusion: An increase in fasting insulin levels is associated with an 8.6- to 14.8-fold increased risk of presenting with colonic adenomas in acromegaly.

This article has been cited by other articles:

				E. Resmini, A. Tagliafico, L. Bacigalupo, G. Giordano, E. Melani, A. Rebora, F. Minuto, G. A. Rollandi, and D. Ferone Computed Tomography Colonography in Acromegaly J. Clin. Endocrinol. Metab., January 1, 2009; 94(1): 218 - 222. [Abstract] [Full Text] [PDF]