Acromegaly represents a rare chronic disease mainly caused by GH pituitary adenoma with increased levels of GH and IGF-I. Diabetes mellitus was shown to increase cardiovascular morbidity and mortality in patients with acromegaly. Management of diabetes in acromegaly represents a challenging matter and deserves special considerations due to multiple factors that might be implicated in hyperglycemia including: i) the etiology of diabetes, which could be related to acromegaly per se. ii) the treatment modality applied for controlling disease activity, such as pasireotide long acting release (PAS-LAR) with remarkable increase rate of hyperglycemia and worsening of preexisting diabetes. iii) the disease activity and the tumor burden taking into consideration the negative effects of GH excess other than hyperglycemia such as weight gain, water retention. Sodium glucose cotransporter inhibitors (SGLT2is) are vastly administrated in patients with T2DM. Despite their cardiovascular safety and superiority this class is not recommended for patients with acromegaly and diabetes. Taking into consideration at least three positive aspects of this class: i) cardiovascular superiority beyond glucose control, ii) weight reduction and osmotic diuresis and iii) decreased insulin levels which might play an important role in GH receptor (GHR) expression and as a result decreased IGF-I levels. The aim of this paper is to focus on the role of SGLT2is in this group of patients and the potential additive effect of this novel class beyond glucose control.
18 - 21 May 2019
European Society of Endocrinology