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Surgical outcomes and predictors of glucose metabolism alterations for growth hormone-secreting pituitary adenomas: a hospital-based study of 151 cases

  • Endocrine Surgery
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Abstract

Purpose

The surgical outcome on glucose metabolism in acromegaly patients is not fully understood. We aimed to investigate the impact of surgery on glucose metabolism and identify key factors that influence alterations of glucose metabolic status in acromegaly patients.

Methods

Oral glucose tolerance test was performed in 151 newly diagnosed acromegaly patients before and 3–12 months after surgery. Insulin resistance and insulin secretion was assessed. Patients were grouped as cured, discordant, and having active disease according to postoperative growth hormone (GH) and insulin-like growth factor-1 (IGF-1) levels. Receiver-operating characteristic curves were generated to determine the optimal cut-off points to predict the impact of surgery on glucose metabolism.

Results

At baseline, 32.5%, 41.7%, and 25.8% patients were categorized as having normal glucose tolerance (NGT), impaired glucose tolerance (IGT), and diabetes mellitus (DM), respectively. After surgery, improved glucose tolerance was observed in 87.3% patients with IGT and 66.7% patients with DM. Deterioration was observed in 14.3% patients with NGT. Glucose tolerance improved in patients with lower preoperative FBG, 2 h-BG, and HbA1c and higher HOMA-β and IGI/IR. The proportion of NGT was significantly increased in surgically cured patients (28.3% vs. 79.2%, P < 0.001) and those with normal GH but elevated IGF-1 levels (25.6% vs. 79.5%, P < 0.001), but not in patients with active disease (42.9% vs. 57.1%, P = 0.131). Baseline FBG < 6.35 mmol/l predicted improved glucose metabolism after surgery.

Conclusions

Glucose metabolic status improved in patients with preserved β-cell function. Preoperative FBG was an independent predictor for improved glucose tolerance status after surgery.

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Acknowledgements

This work was supported by the National Natural Science Foundation of China (Grant numbers 81602191, 81702467), the Shanghai Municipal Commission of Health and Family Planning (Grant number XYQ201640058), and the Shanghai Sailing Program (Grant number 17YF1401500).

Funding

This study was funded by the National Natural Science Foundation of China (Grant numbers 81602191, 81702467), the Shanghai Municipal Commission of Health and Family Planning (Grant number XYQ201640058), and the Shanghai Sailing Program (Grant number 17YF1401500).

Author information

Author notes

  1. These authors contributed equally: Wenqiang He, Linling Yan, Meng Wang.

Authors and Affiliations

  1. Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, 200040, China

    Wenqiang He, Zengyi Ma, Zhao Ye, Qilin Zhang, Yichao Zhang, Nidan Qiao, Xuefei Shou, Yao Zhao, Shiqi Li, Ming Shen & Yongfei Wang

  2. Department of Endocrinology, the First People’s Hospital of Taicang, Jiangsu, 215400, China

    Linling Yan

  3. Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, 200040, China

    Meng Wang, Min He, Hongying Ye, Bin Lu, Yiming Li & Zhaoyun Zhang

  4. Department of Endocrinology and Metabolism, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University, Shanghai, 200011, China

    Qin Li

  5. Department of Nuclear Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, China

    Yun Lu

Authors
  1. Wenqiang He
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  2. Linling Yan
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  3. Meng Wang
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  4. Qin Li
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  5. Min He
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  19. Ming Shen
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  20. Yongfei Wang
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Corresponding authors

Correspondence to Ming Shen or Yongfei Wang.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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He, W., Yan, L., Wang, M. et al. Surgical outcomes and predictors of glucose metabolism alterations for growth hormone-secreting pituitary adenomas: a hospital-based study of 151 cases. Endocrine 63, 27–35 (2019). https://doi.org/10.1007/s12020-018-1745-7

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  • DOI: https://doi.org/10.1007/s12020-018-1745-7

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