Glucose homeostasis in acromegaly: pathogenesis and effects of treatment

Baldelli, Roberto and Auriemma, Renata S. and Rizza, Laura and Rota, Francesca and Adinolfi, Valerio and Paoloni, Antonella and Di Giacinto, Paola and Barnabei, Agnese and Appetecchia, Marialuisa and Gasperi, Maurizio (2013) Glucose homeostasis in acromegaly: pathogenesis and effects of treatment. Reviews in endocrinology and metabolism, 1 (1). pp. 46-53. ISSN 2282-8362

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Abstract

Acromegaly is a chronic debilitating disorder resulting from excessive secretion of growth hormone (GH) and consequent increase in insulin-like growth factor I (IGF-I), usually caused by a pituitary somatotroph adenoma. Effective treatment aims to ameliorate symptoms and signs of the disease and to lower mortality rate. In particular, high morbidity and mortality are partly related to the presence of insulin resistance due to the action of GH on liver, muscle and adipose tissue. Insulin resistance and/or reduced insulin sensitivity physiologically result in hypersecretion of insulin from the pancreas. This compensatory state of hyperinsulinemia is felt to be a first and more important marker for this condition. Adequate control of GH excess by surgery or pharmacotherapy is associated with decreased insulin resistance, resulting in reduced plasma insulin and glucose levels or improved glucose tolerance. Despite divergent effects of both somatostatin and somatostatin analogs on GH, insulin and glucagon secretion, and glucose absorption, treatment with the somatostatin analogs octreotide and lanreotide has only limited effects on glucose metabolism. However, glucose sensitivity has been formally examined using a hyperinsulinemic euglycemic clamp only in a minority of studies. Treatment with the GH-receptor antagonist pegvisomant improves insulin sensitivity, thus decreasing circulating fasting insulin and glucose levels. Assessment of insulin secretion and glucose levels in acromegalic patients during administration of the above compounds is thus mandatory.

Item Type:	Article
Uncontrolled Keywords:	Acromegaly, insulin-resistance, glucose homeostasis, pegvisomant, somatostatin analog, octreotide, lanreotide
Subjects:	600 Tecnologia - Scienze applicate > 610 Medicina e salute (Classificare qui la tecnologia dei servizi medici) > 616 Malattie (classificare qui la Clinica medica, la medicina basata sull'evidenza, la Medicina interna, la Medicina sperimentale) > 616.4 Malattie del sistema emopoietico, linfatico, ghiandolare; Malattie del sistema endocrino
Depositing User:	Matteo Viola
Date Deposited:	17 Jun 2014 13:07
Last Modified:	17 Jun 2014 13:07
URI:	http://eprints.bice.rm.cnr.it/id/eprint/8541

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