High risk of impaired glucose tolerance and diabetes mellitus is frequently observed in acromegalic patients. Some studies have reported a direct correlation between circulating GH levels and the degree of glucose intolerance. Microalbuminuria clusters with the metabolic syndrome and both conditions predict cardiovascular disease mortality. The reported relationships of microalbuminuria with the individual components of the metabolic syndrome are variable. Aim of this preliminary study was to investigate the endothelial function in acromegalic patients during octreotide-LAR trearment. Sixty five acromegalics aged 47.6±11.9 yrs., BMI 32.±4.7, underwent OGTT and hormonal/biochemical evaluation, in basal condition and after octreotide-LAR treatment. In particular, 24 hours urine were collected to evaluate microalbuminuria as index of endothelial damage. Glucose homeostasis was evaluated with OGTT insulin sensitivity index (ISI). In the whole group, mean pre-treatment GH and IGF-I levels were 25.3±3.9 ng/ml and 683.2±24.02 ng/ml, respectively. After six months GH and IGF-I levels were 2.6±0.5 ng/ml and 334.9±23.4 ng/ml, respectively (P<0.005); data about glucose homeostasis were reported in the following Table 1.
As far as microalbuminuria is concerned, during treatment with somatostatin analogues, a clear reduction was observed (26.4±2.5 μg/24 h and 18.04±2.3 μg/24 h, respectively; P<0.005). After octreotide-LAR treatment, a negative correlation was found between ISI index and microalbuminuria (P<0.05). In conclusion, treatment with octreotide LAR is likely to improve insulin resistance and reduce microalbuminuria in acromegaly; this would therefore preserve kidney function and reduce cardiovascular risk besides normalization of GH/IGF-I hypersecretion.
01 - 05 Apr 2006
European Society of Endocrinology