Abstract
To determine the prevalence of diabetes, glucose intolerance and impaired fasting glucose in Mexican patients with acromegaly and establish associations with clinical, anthropometric and biochemical variables. 257 patients with acromegaly were evaluated by a 75 g-oral glucose tolerance test with measurements of both GH and glucose (0, 30, 60, 90 120 min) as well as baseline IGF-1. Normal glucose tolerance (NGT), impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and diabetes (DM) were defined based on the 2003 ADA criteria. NGT, IFG, IGT and DM were found in 27.6, 8.9, 31.6 and 31.9% of the subjects, respectively; 42 of the DM patients were unaware of the diagnosis. Patients with diabetes were older than subjects in the other 3 categories (P = 0.001), and the proportion of women was significantly higher in the DM (74%) and IGT (68%) groups than in the NGT group (52%) (P = 0.004). Odds ratio for the development of DM was 3.29 (95% CI 3.28–3.3). GH and IGF-1 levels were comparable among the different groups. In a multivariable analysis DM was significantly associated with age, presence of a macroadenoma, disease duration and a basal GH > 30 μg/dl. DM and probably IGT are more prevalent in acromegaly than in the general Mexican population. DM was more frequent in females of all ages, in subjects with severely elevated GH concentrations, in patients with macroadenomas, and long-standing disease duration. The odds ratio for DM in our subjects with acromegaly is more than 3 times higher than in the general population.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Møller O, Jørgensen J (2009) Effects of growth hormone on glucose, lipid, and protein metabolism in human subjects. Endocr Rev 30:152–177
Resmini E, Minuto F, Colao A, Ferone D (2009) Secondary diabetes associated with principal endocrinopathies: the impact of new treatment modalities. Acta Diabetol. doi:10.1007/s00592-009-0112-9
Colao A, Ferone D, Marzullo P, Lombardi G (2004) Systemic complications of acromegaly: epidemiology, pathogenesis, and management. Endocr Rev 25:102–152
Biering H, Knappe G, Gerl H, Lochs H (2002) Prevalence of diabetes in acromegaly and Cushing syndrome. Acta Med Austr 27:27–31
Kreze A, Kreze-Spiroval E, Mikulecky M (2001) Risk factors for glucose intolerance in active acromegaly. Braz J Med Biol Res 34:1429–1433
Colao A, Baldelli R, Marzullo P, Ferretti E, Ferone D, Gargiulo P, Petretta M, Tamburrano G, Lombardi G, Liuzzi A (2000) Systemic hypertension and impaired glucose tolerance are independently correlated to the severity of the acromegalic cardiomiopathy. J Clin Endocrinol Metab 85:193–198
Stelmachowska-Banas M, Zdunowski P, Zgliczyński W (2009) Abnormalities in glucose homeostasis in acromegaly. Does the prevalence of glucose intolerance depend on the level of activity of the disease and the duration of the symptoms? Endokrynol Pol 60:20–24
Nabarro J (1987) Acromegaly. Clin Endocrinol 26:481–512
The Expert Committee on the Diagnosis, Classification of Diabetes Mellitus (2003) Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care 26:3160–3167
Haffner S, Kennedy E, Gonzales C, Stern M, Miettinen H (1996) A prospective analysis of the HOMA model. The Mexico City Diabetes Study. Diabetes Care 19:1138–1141
Houssay B (1936) The hypophysis and metabolism. N Engl J Med 214:961–985
Villalpando S, de la Cruz V, Rojas R, Shamah-Levy T, Ávila M, Gaona B (2010) Prevalence and distribution of type 2 diabetes mellitus in Mexican adult population. A probabilistic survey. Salud Publ Mex 52(Suppl 1):519–526
Aguilar C, Velazquez O, Gómez F, González A, Lara A, Molina V, Rull J, Tapia R (2003) Characteristics of patients with type 2 diabetes in México. Results from a large population-based nationwide survey. Diabetes Care 26:2021–2026
Mercado M, Espinosa de los Monteros AL, Sosa E, Cheng S, Mendoza V, Hernández I, Sandoval C, Guinto G, Molina M (2004) Clinical-biochemical correlations in acromegaly at diagnosis and the real prevalence of biochemically discordant disease. Horm Res 62:293–299
Puder J, Nilavar S, Post K, Freda P (2005) Relationship between disease related morbidity and biochemical markers of activity in patients with acromegaly. J Clin Endocrinol Metab 90:1972–1978
Serri O, Beauregard C, Hardy J (2004) Long term biochemical status and disease related morbidity in 53 postoperative patients with acromegaly. J Clin Endoccrinol Metab 89:658–661
Alexopoulou O, Bex M, Abs R, TSjoen G, Velkeniers B, Maiter D (2008) Divergence between growth hormone and insulin like growth factor-1 concentrations in the follow up of acromegaly. J Clin Endocrinol Metab 93:1324–1330
Conflict of interest
Drs. Ana Laura Espinosa de los Monteros, Guadalupe Vargas, Baldomero González, Ernesto Sosa, and Moisés Mercado have no conflicts of interest to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Espinosa-de-los-Monteros, A.L., González, B., Vargas, G. et al. Clinical and biochemical characteristics of acromegalic patients with different abnormalities in glucose metabolism. Pituitary 14, 231–235 (2011). https://doi.org/10.1007/s11102-010-0284-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11102-010-0284-x