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Protein Metabolism in Acromegaly: Differential Effects of Short- and Long-Term Treatment

Department of Endocrinology (J.G., T.W., M.G.B., K.-C.L., K.K.Y.H.), St. Vincent’s Hospital, and Garvan Institute of Medical Research, Sydney, New South Wales 2010, Australia; University of New South Wales (M.G.B., K.-C.L., K.K.Y.H.), Sydney, New South Wales 2031, Australia; and Department of Diabetes and Endocrinology (A.M.U.), Guy’s, King’s and St. Thomas’ School of Medicine, St. Thomas’ Hospital, London SE1 7EH, United Kingdom

Address all correspondence and requests for reprints to: Ken K.Y. Ho, Professor of Medicine, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, New South Wales 2010, Australia. E-mail: k.ho{at}garvan.org.au.

Context: GH acutely increases body protein by stimulating protein synthesis and reducing protein oxidation.

Objective: The objective of the study was to determine whether these changes in protein metabolism are sustained in long-term GH excess and reversed by correction.

Design: We conducted a cross-sectional study in 16 acromegalic and 18 normal subjects and a longitudinal study in which acromegalic subjects were studied before and after short-term (n = 8) or long-term (n = 10) treatment.

Setting: The study was conducted at a clinical research center.

Main Outcome Measures: Whole-body rates of leucine appearance (leucine Ra; an index of protein breakdown), leucine oxidation, and nonoxidative leucine disposal (NOLD; an index of protein synthesis) estimated using infusion of 1-[¹³C] leucine were measured.

Results: Leucine Ra and NOLD were greater (P < 0.01) in acromegalic compared with normal subjects, whereas leucine oxidation did not differ. Leucine oxidation increased significantly (P < 0.05) after short-term treatment but returned to baseline after long-term treatment. Both leucine Ra and NOLD decreased significantly (P < 0.05) after short- and long-term treatment. Adjustment for body composition did not affect results.

Conclusions: In acromegalic subjects, protein breakdown and synthesis are increased, whereas protein oxidation does not differ from normal subjects. Protein oxidation increases transiently, whereas protein breakdown and synthesis are stably reduced after treatment. Because protein oxidation represents irreversible loss, we conclude that the normal state of protein oxidation found in acromegaly and after long-term treatment represents metabolic adaptation, which maintains protein mass at a steady state after stable changes in GH status.

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