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Changes in metabolic parameters and cardiovascular risk factors after therapeutic control of acromegaly vary with the treatment modality. Data from the Bicêtre cohort, and review of the literature

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Summary

Context

Untreated acromegaly is associated with increased morbidity and mortality due to malignant, cardiovascular, and cerebrovascular disorders. Effective treatment of acromegaly reduces excess mortality, but its impact on cardiovascular risk factors and metabolic parameters are poorly documented.

Aim

We analyzed changes in cardiovascular risk factors and metabolic parameters in patients receiving various treatment modalities.

Patients and methods

We retrospectively studied 96 patients with acromegaly, both at diagnosis and after IGF-I normalization following surgery alone (n = 51) or medical therapy with first generation somatostatin analogues (SSA, n = 23), or pegvisomant (n = 22). Duration of follow-up was 77 (42–161) months, 75 (42–112) months, and 62 (31–93) months, in patients treated with surgery alone, SSA, and pegvisomant, respectively. In all the cases except four, patients treated medically had underwent previous unsuccessful surgery.

Results

IGF-I normalization was associated with increased body weight, decreased systolic blood pressure (SBP) in hypertensive patients, decreased fasting plasma glucose (FPG) and HOMA-IR and HOMA-B levels, increased HDL cholesterol (HDLc); whereas, LDL cholesterol (LDLc) was not significantly different. Plasma PCSK9 levels were unchanged in patients with available values. Cardiovascular and metabolic changes varied with the treatment modality: surgery, but not pegvisomant, had a beneficial effect on SBP; FPG decreased after surgery but increased after SSA; the decline in HOMA-IR was only significant after surgery; pegvisomant significantly increased LDLc and total cholesterol; whereas SA increased HDLc and had no effect on LDLc levels.

Conclusion

Treatments used to normalize IGF-I levels in patients with acromegaly could have differential effects on cardiovascular risk factors and metabolic parameters.

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Authors and Affiliations

  1. Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Service d’Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l’Hypophyse, F-94275, Le Kremlin Bicêtre, France

    Claire Briet, Mirela Diana Ilie, Emmanuelle Kuhn, Luigi Maione, Sylvie Salenave & Philippe Chanson

  2. Institut MITOVASC, INSERM U1083, Université d’Angers, Département d’Endocrinologie, Diabétologie et Nutrition, Centre Hospitalier Universitaire d’Angers, F-49933, Angers, France

    Claire Briet

  3. Univ Paris-Sud, Faculté de Médecine Paris-Sud, F-94276, Le Kremlin Bicêtre, France

    Emmanuelle Kuhn, Luigi Maione, Sylvie Brailly-Tabard & Philippe Chanson

  4. Unité Mixte de Recherche-S1185, F-94276, Le Kremlin Bicêtre, France

    Emmanuelle Kuhn, Luigi Maione, Sylvie Brailly-Tabard & Philippe Chanson

  5. Institut National de la Santé et de la Recherche Médicale (INSERM) U1185, F-94276, Le Kremlin Bicêtre, France

    Emmanuelle Kuhn, Luigi Maione, Sylvie Brailly-Tabard & Philippe Chanson

  6. l’Institut du Thorax, INSERM, CNRS, Univ Nantes, CHU Nantes, F-44000, Nantes, France

    Bertrand Cariou

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Disclosure of potential conflicts of interest: P.C. is a consultant for Novartis, Ipsen, and Pfizer. Honoraria and lecture fees from Novartis, Ipsen, and Pfizer have been paid to his institution. The Service d’Endocrinologie et des Maladies de la Reproduction, Hôpital de Bicêtre, has received educational and research grants from Novartis, Ipsen, and Pfizer. B.C. has received research funding from Pfizer and Sanofi-Regeneron, and honoraria from Amgen, AstraZeneca, Pierre Fabre, Janssen, Eli-Lilly, MSD Merck & Co., Novartis, Novo-Nordisk, Sanofi, and Takeda. All the remaining authors declare that they have no conflict of interest.

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All procedures performed in this study 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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Briet, C., Ilie, M.D., Kuhn, E. et al. Changes in metabolic parameters and cardiovascular risk factors after therapeutic control of acromegaly vary with the treatment modality. Data from the Bicêtre cohort, and review of the literature. Endocrine 63, 348–360 (2019). https://doi.org/10.1007/s12020-018-1797-8

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