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No differences in metabolic outcomes between nadir GH 0.4 and 1.0 ng/mL during OGTT in surgically cured acromegalic patients (observational study)

View Article: PubMed Central - PubMed

ABSTRACT

Metabolic impairment is the common cause for mortality in acromegalic patients. In this study, long-term improvements of metabolic parameters were evaluated according to 2 different remission criteria.

This was an observational cohort study before and up to 1 year after transsphenoidal adenomectomy (TSA). Participants were 187 patients with acromegaly. At 6 months after TSA, remitted patients with age- and sex-matched normalized IGF-1 were divided into 2 groups: remission 1 (R1), nadir growth hormone (GH) below 0.4 ng/mL; and remission 2 (R2), nadir GH between 0.4 and 1.0 ng/mL in oral glucose tolerance test (OGTT). Metabolic parameters during serial OGTTs were evaluated for 12 months. Remission was achieved in 157 (R1–136; R2–21) patients. Immediate postoperative metabolic parameters including body weight, body mass index, glucose, insulin, and free fatty acid in OGTT were all significantly improved in R1 and R2. HOMA-%β and HOMA-IR scores also improved in both R1 and R2. These improvements persisted for duration (12 months) of this study. However, no difference was present in metabolic parameters between R1 and R2. Although the patients with preoperative adrenal insufficiency presented significantly increased HOMA scores before TSA, there was no difference between classifications of deficient pituitary axes and changes of metabolic parameters after TSA. Remitted patients exhibited rapid restoration of metabolic parameters immediate postoperative period. Long-term improvements in metabolic parameters were not different between the 2 different nadir GH cut-offs, 0.4 and 1.0 ng/mL.

No MeSH data available.


Related in: MedlinePlus

Changes free fatty acids during 75 g glucose tolerance test. During 75 g oral glucose tolerance tests, free fatty acids were measured serially before, at a week, at 6 months, and at 12 months after transsphenodial adenomectomy. At each period, there was no difference in fasting (A) and glucose-suppressed (B) free fatty acids between different cut-off GH values. White box: patients in remission with age-matched and sex-matched normal IGF-1 levels and nadir GH levels below 0.4 ng/mL (R1). Gray box: patients with age-matched and sex-matched normal IGF-1 levels and nadir GH levels ranging from 0.4 to 1.0 ng/mL (R2). Boxes indicate interquartile ranges. Horizontal bars indicate median levels.
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Figure 1: Changes free fatty acids during 75 g glucose tolerance test. During 75 g oral glucose tolerance tests, free fatty acids were measured serially before, at a week, at 6 months, and at 12 months after transsphenodial adenomectomy. At each period, there was no difference in fasting (A) and glucose-suppressed (B) free fatty acids between different cut-off GH values. White box: patients in remission with age-matched and sex-matched normal IGF-1 levels and nadir GH levels below 0.4 ng/mL (R1). Gray box: patients with age-matched and sex-matched normal IGF-1 levels and nadir GH levels ranging from 0.4 to 1.0 ng/mL (R2). Boxes indicate interquartile ranges. Horizontal bars indicate median levels.

Mentions: Serial OGTTs were performed to evaluate the biochemical status of acromegaly, glucose, insulin, C-peptide, and FFA. In R1, all metabolic parameters tested had improved significantly by 1 week after TSA. These parameters included body weight, body mass index (BMI), fasting glucose, fasting insulin, fasting, and postglucose suppressed FFA during the OGTT (Table 2). Moreover, these improvements were maintained over all subsequent OGTTs. The fasting FFA level decreased abruptly at a week and then slightly increased by 6 months after TSA (452 vs. 172 vs. 344 vs. 350 mEq/L; before, at a week, at 6 months, and at 12 months after TSA, respectively). Postglucose suppressed FFA level during the OGTT maintained significantly lower than that of preoperative OGTT since a week after TSA (80 vs. 44 vs. 39 vs. 34 mEq/L; before, at a week, at 6 months, and at 12 months after TSA, respectively). Furthermore, those values persisted for at least 12 months after TSA (Fig. 1).


No differences in metabolic outcomes between nadir GH 0.4 and 1.0 ng/mL during OGTT in surgically cured acromegalic patients (observational study)
Changes free fatty acids during 75 g glucose tolerance test. During 75 g oral glucose tolerance tests, free fatty acids were measured serially before, at a week, at 6 months, and at 12 months after transsphenodial adenomectomy. At each period, there was no difference in fasting (A) and glucose-suppressed (B) free fatty acids between different cut-off GH values. White box: patients in remission with age-matched and sex-matched normal IGF-1 levels and nadir GH levels below 0.4 ng/mL (R1). Gray box: patients with age-matched and sex-matched normal IGF-1 levels and nadir GH levels ranging from 0.4 to 1.0 ng/mL (R2). Boxes indicate interquartile ranges. Horizontal bars indicate median levels.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998443&req=5

Figure 1: Changes free fatty acids during 75 g glucose tolerance test. During 75 g oral glucose tolerance tests, free fatty acids were measured serially before, at a week, at 6 months, and at 12 months after transsphenodial adenomectomy. At each period, there was no difference in fasting (A) and glucose-suppressed (B) free fatty acids between different cut-off GH values. White box: patients in remission with age-matched and sex-matched normal IGF-1 levels and nadir GH levels below 0.4 ng/mL (R1). Gray box: patients with age-matched and sex-matched normal IGF-1 levels and nadir GH levels ranging from 0.4 to 1.0 ng/mL (R2). Boxes indicate interquartile ranges. Horizontal bars indicate median levels.
Mentions: Serial OGTTs were performed to evaluate the biochemical status of acromegaly, glucose, insulin, C-peptide, and FFA. In R1, all metabolic parameters tested had improved significantly by 1 week after TSA. These parameters included body weight, body mass index (BMI), fasting glucose, fasting insulin, fasting, and postglucose suppressed FFA during the OGTT (Table 2). Moreover, these improvements were maintained over all subsequent OGTTs. The fasting FFA level decreased abruptly at a week and then slightly increased by 6 months after TSA (452 vs. 172 vs. 344 vs. 350 mEq/L; before, at a week, at 6 months, and at 12 months after TSA, respectively). Postglucose suppressed FFA level during the OGTT maintained significantly lower than that of preoperative OGTT since a week after TSA (80 vs. 44 vs. 39 vs. 34 mEq/L; before, at a week, at 6 months, and at 12 months after TSA, respectively). Furthermore, those values persisted for at least 12 months after TSA (Fig. 1).

View Article: PubMed Central - PubMed

ABSTRACT

Metabolic impairment is the common cause for mortality in acromegalic patients. In this study, long-term improvements of metabolic parameters were evaluated according to 2 different remission criteria.

This was an observational cohort study before and up to 1 year after transsphenoidal adenomectomy (TSA). Participants were 187 patients with acromegaly. At 6 months after TSA, remitted patients with age- and sex-matched normalized IGF-1 were divided into 2 groups: remission 1 (R1), nadir growth hormone (GH) below 0.4 ng/mL; and remission 2 (R2), nadir GH between 0.4 and 1.0 ng/mL in oral glucose tolerance test (OGTT). Metabolic parameters during serial OGTTs were evaluated for 12 months. Remission was achieved in 157 (R1–136; R2–21) patients. Immediate postoperative metabolic parameters including body weight, body mass index, glucose, insulin, and free fatty acid in OGTT were all significantly improved in R1 and R2. HOMA-%β and HOMA-IR scores also improved in both R1 and R2. These improvements persisted for duration (12 months) of this study. However, no difference was present in metabolic parameters between R1 and R2. Although the patients with preoperative adrenal insufficiency presented significantly increased HOMA scores before TSA, there was no difference between classifications of deficient pituitary axes and changes of metabolic parameters after TSA. Remitted patients exhibited rapid restoration of metabolic parameters immediate postoperative period. Long-term improvements in metabolic parameters were not different between the 2 different nadir GH cut-offs, 0.4 and 1.0 ng/mL.

No MeSH data available.


Related in: MedlinePlus