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Glucose intolerance in acromegaly is driven by low insulin secretion; results from an intravenous glucose tolerance test

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Abstract

Purpose

Insulin sensitivity (Si) and its role in glucose intolerance of acromegaly has been extensively evaluated. However, data on insulin secretion is limited. We aimed to assess stimulated insulin secretion using an intravenous glucose tolerance test (IVGTT) in active acromegaly.

Methods

We performed an IVGTT in 25 patients with active acromegaly (13 normal glucose tolerance [NGT], 6 impaired glucose tolerance [IGT] and 6 diabetes mellitus [DM]) and 23 controls (8 lean NGT, 8 obese NGT and 7 obese IGT). Serum glucose and insulin were measured at 20 time points along the test to calculate Si and acute insulin response (AIRg). Medical treatment for acromegaly or diabetes was not allowed.

Results

In acromegaly, patients with NGT had significantly (p for trend < 0.001) higher AIRg (3383 ± 1082 pmol*min/L) than IGT (1215 ± 1069) and DM (506 ± 600). AIRg was higher in NGT (4764 ± 1180 pmol*min/L) and IGT (3183 ± 3261) controls with obesity than NGT (p = 0.01) or IGT (p = 0.17) acromegaly. Si was not significantly lower in IGT (0.68 [0.37, 0.88] 106*L/pmol*min) and DM (0.60 [0.42, 0.84]) than in NGT (0.81 [0.58, 1.55]) patients with acromegaly. NGT (0.33 [0.30, 0.47] 106*L/pmol*min) and IGT (0.37 [0.21, 0.66]) controls with obesity had lower Si than NGT (p = 0.001) and IGT (p = 0.43) acromegaly.

Conclusion

We demonstrated that low insulin secretion is the main driver behind glucose intolerance in acromegaly. Compared to NGT and IGT controls with obesity, patients with NGT or IGT acromegaly had higher Si. Together, these findings suggest that impaired insulin secretion might be a specific mechanism for glucose intolerance in acromegaly.

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Data availability

Raw data are available from the corresponding author upon reasonable request.

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Acknowledgements

We want to thank Professor Maria Fleseriu, MD, for helpful discussion and advice for this manuscript.

Funding

This work supported by the 57404559/11.11.2019 Independent Research Grant from Pfizer and 28332/04.11.2013 Young Researches Grant from Carol Davila University of Medicine and Pharmacy.

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Authors and Affiliations

  1. Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, 34-38 Aviatorilor blvd, Bucharest, 011863, Romania

    Laura Georgiana Zaifu, Dan Alexandru Niculescu, Iulia Florentina Burcea & Catalina Poiana

  2. First Endocrinology Department, C. I. Parhon National Institute of Endocrinology, Bucharest, Romania

    Dan Alexandru Niculescu, Roxana Dusceac, Iulia Florentina Burcea & Catalina Poiana

  3. Research Laboratory, C. I. Parhon National Institute of Endocrinology, Bucharest, Romania

    Andreea Elena Kremer & Andra Caragheorgheopol

  4. Clinical Laboratory, C. I. Parhon National Institute of Endocrinology, Bucharest, Romania

    Mariana Sava & Carmen Nicoleta Iordachescu

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  1. Laura Georgiana Zaifu
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  7. Roxana Dusceac
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Contributions

Study design: L.G.Z., D.A.N. and C.P. Data collection: L.G.Z., D.A.N., A.E.K., A.C., M.S., C.N.I., R.D. and I.F.B. Data interpretation: L.G.Z. and D.A.N. Writing: L.G.Z., D.A.N. and R.D. Critical review and approval of the final version: all authors.

Corresponding author

Correspondence to Dan Alexandru Niculescu.

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Ethical approval

The study was approved by the C. I. Parhon National Institute of Endocrinology Ethics Committee (No 9/27.03.2020).

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The authors declare no competing interests.

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Zaifu, L.G., Niculescu, D.A., Kremer, A.E. et al. Glucose intolerance in acromegaly is driven by low insulin secretion; results from an intravenous glucose tolerance test. Pituitary 27, 178–186 (2024). https://doi.org/10.1007/s11102-024-01386-z

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