Mixed Metabolic Profiles Found in Acromegaly Remission

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Acromegaly

During acromegaly remission, adiposity and some cardiovascular risk factors increased, researchers reported in the Journal of Clinical Endocrinology & Metabolism.

“Epidemiological data report that biochemical remission of acromegaly is associated with a reduction of its excess mortality, including that due to cardiovascular disease, to population expected rates,” they wrote.

“On a patient level, however, cross-sectional studies suggest that some factors associated with increased (CV) risk, including adiposity, may be greater after remission than before.”

Carlos Reyes-Vidal, MD, of Columbia University College of Physicians and Surgeons in New York, and colleagues evaluated 42 untreated adults with active acromegaly. They ultimately assessed metabolic and CV risk parameters in 26 patients who achieved remission and 16 with persistent active acromegaly after surgery.

Remission was defined as normal insulin-like growth factor I (IGF-1).

At 6 months and for 32 months after surgery, total ghrelin, body weight, waist circumference, C-reactive protein, homocysteine, HDL and leptin increased after remission. At the same time, systolic blood pressure, homeostasis model assessment, triglycerides and lipoprotein (a) were decreased.

Results linked the increase in ghrelin with a decrease in growth hormone, IGF-1, and insulin and insulin resistance.

In the group with active acromegaly, however, no significant increases in weight, waist circumference and ghrelin occurred.

Remission was also associated with increases in total body fat, trunk fat and percentage total body fat at 1 year after surgery in 15 patients, which also correlated with a rise in ghrelin.

These results suggest a connection between ghrelin and these metabolic and CV changes, but further study is needed, according to the researchers.

“The increase in weight and adiposity is a clinically recognizable problem for many successfully treated patients. In an individual patient with acromegaly, it is unknown whether the changes represent a readjustment to the anthropometric and CV risk profile they would have were they not to have acromegaly,” the researchers wrote.

Reference

  1. Reyes-Vidal C et al. J Clin Endocrinol Metab. 2014;doi:10.1210/jc.2014-2259.
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