Endocrine Abstracts

Background: Transsphenoidal surgery (TSS) is able to determine the biochemical remission of acromegaly in 45%–80% of the patients, thereby inducing an improvement of cardiovascular function and glucose metabolism. Only 3–5% of acromegalics are diagnosed over 65-years-old, so few data are available about post-operative cardiovascular and metabolic changes in this group.

Patients and Methods: Fifteen acromegalic patients ≥65 years-old who underwent successful TSS were studied. Doppler-echocardiography and 24-hour ambulatory blood pressure monitoring (ABPM) studies were performed immediately before and 6 months after TSS. Calculation of insulin sensitivity was derived from OGTT.

Results: Both left ventricular mass (LVM) and LVM index decreased significantly after surgery (P=0.0021 and P=0.0015, respectively). Nine out of 13 patients who fulfilled echocardiographic criteria for left ventricular hypertrophy (LVH) before surgery normalized LVMi, whereas LVH persisted in 3 hypertensive patients. Significant post-operative improvement of diastolic function was also observed. 24-h systolic BP (123.5±12.2 vs 131.1±15.6 mmHg, P=0.003) and diurnal diastolic BP (76.9±7.8 vs 81.6±6.3 mmHg, P=0.04) decreased after surgery. Three out of the 9 patients who were pre-operatively defined as hypertensive according to ABPM had normal post-operative diurnal BP values. Glucose metabolism improved after surgery, with a significant decrease of fasting (P<0.05) and post-load (P<0.01) glucose and insulin levels. This was associated with an improvement on insulin sensitivity (P<0.003).

Conclusions: Successful TSS is able to induce a significant improvement of cardiac mass and function even in elderly acromegalics, and this is associated with a slight decrease in BP values and improvement of glucose metabolism abnormalities. Long-term studies are necessary to evaluate the effect of biochemical cure on cardiovascular morbidity and mortality in such patients.