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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

Categorization of glucose homeostasis during the 75 g glucose tolerance test. According to the result of the 75 g oral glucose tolerance test, each patient was classified into one of the following 3 categories: diabetes mellitus (DM), impaired fasting glucose (IFG)/impaired glucose tolerance (IGT), and normal. No significant differences were observed between patients of R1 (A) and R2 (B).
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Figure 3: Categorization of glucose homeostasis during the 75 g glucose tolerance test. According to the result of the 75 g oral glucose tolerance test, each patient was classified into one of the following 3 categories: diabetes mellitus (DM), impaired fasting glucose (IFG)/impaired glucose tolerance (IGT), and normal. No significant differences were observed between patients of R1 (A) and R2 (B).

Mentions: During the OGTT, patients were classified as normal, IFG/IGT, or DM. Although only 15.0% reported previously diagnosed DM, half of the enrolled patients were categorized as DM through the preoperative OGTT. As shown in the changes of HOMA-IR and other metabolic parameters, the classifications of glucose homeostasis during OGTT improved abruptly after TSA and were maintained thereafter for at least 12 months. Regarding glucose homeostasis in the OGTT, similar patterns of change were observed between R1 and R2 (Fig. 3A and B). Among the 67 patients of R1 with DM in the preoperative OGTT, 30 (45.3%) exhibited improved glucose tolerance at 1 week after TSA.


No differences in metabolic outcomes between nadir GH 0.4 and 1.0 ng/mL during OGTT in surgically cured acromegalic patients (observational study)
Categorization of glucose homeostasis during the 75 g glucose tolerance test. According to the result of the 75 g oral glucose tolerance test, each patient was classified into one of the following 3 categories: diabetes mellitus (DM), impaired fasting glucose (IFG)/impaired glucose tolerance (IGT), and normal. No significant differences were observed between patients of R1 (A) and R2 (B).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Categorization of glucose homeostasis during the 75 g glucose tolerance test. According to the result of the 75 g oral glucose tolerance test, each patient was classified into one of the following 3 categories: diabetes mellitus (DM), impaired fasting glucose (IFG)/impaired glucose tolerance (IGT), and normal. No significant differences were observed between patients of R1 (A) and R2 (B).
Mentions: During the OGTT, patients were classified as normal, IFG/IGT, or DM. Although only 15.0% reported previously diagnosed DM, half of the enrolled patients were categorized as DM through the preoperative OGTT. As shown in the changes of HOMA-IR and other metabolic parameters, the classifications of glucose homeostasis during OGTT improved abruptly after TSA and were maintained thereafter for at least 12 months. Regarding glucose homeostasis in the OGTT, similar patterns of change were observed between R1 and R2 (Fig. 3A and B). Among the 67 patients of R1 with DM in the preoperative OGTT, 30 (45.3%) exhibited improved glucose tolerance at 1 week after TSA.

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