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Impact of Somatostatin Analogs Versus Surgery on Glucose Metabolism in Acromegaly: Results of a 5-Year Observational, Open, Prospective Study

Department of Molecular and Clinical Endocrinology and Oncology (A.C., R.S.A., M.G., L.F.S.G., G.L., R.P.), Section of Endocrinology, University "Federico II" of Naples, 80131 Naples, Italy; and Department of Neurological Sciences (P.C., L.M.C., F.E.), Section of Neurosurgery, University "Federico II" of Naples, 80131 Naples, Italy

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

Objective: The aim of the study was to investigate the 5-yr impact of surgery and somatostatin analogs (SSA) on glucose metabolism in acromegaly.

Design: We conducted an observational, prospective, comparative, nonrandomized study.

Patients: The 100 patients (48 women, 52 men; median age, 49 yr) in the study were grouped as follows for treatment: SSA only (group A; n = 34); SSA followed by surgery (group B; n = 20); surgery only (group C; n = 30); and surgery followed by SSA (group D; n = 16).

Results: At diagnosis, 28% had impaired glucose tolerance, and 22% had diabetes mellitus; fasting glucose levels (4.13–10.60 mmol/liter) were best predicted by age (t = 2.88; P = 0.0049) and disease duration (t = 1.99; P = 0.049). After 60 months, fasting glucose levels reduced (–4.9 ± 19.7%) in group A only, whereas they did not change in the other groups. In the 68 nondiabetic patients at baseline, fasting glucose levels increased by 0.7 ± 11.2%, 7.5 ± 10.3%, 4.3 ± 10.4%, and 4.3 ± 14.8% (P = 0.28), from groups A to D, respectively. Percentage change of fasting glucose in all patients receiving SSA was 1.9 ± 12.3%, and in those not receiving SSA it was 6.4 ± 10.8% (P = 0.13). Overall, prevalence of new onset of diabetes during SSA treatment was nine of 55 (16.4%) vs. three of 23 after surgery (13.0%, P = 0.98). Deterioration of glucose tolerance was correlated with increased body mass index (r = 0.49, P < 0.0001) and not with use of SSA or surgery (r = 0.06; P = 0.53), control or not of GH (r = –0.10, P = 0.31) and IGF-I (r = –0.12; P = 0.22).

Conclusions: The results of this study demonstrate a similar deterioration of glucose tolerance after 60 months in patients receiving SSA or cured with surgery. Increase in body mass index was the major predictor of deterioration of glucose tolerance.

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				A. Colao, R. S. Auriemma, M. Galdiero, G. Lombardi, and R. Pivonello Effects of Initial Therapy for Five Years with Somatostatin Analogs for Acromegaly on Growth Hormone and Insulin-Like Growth Factor-I Levels, Tumor Shrinkage, and Cardiovascular Disease: A Prospective Study J. Clin. Endocrinol. Metab., October 1, 2009; 94(10): 3746 - 3756. [Abstract] [Full Text] [PDF]