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Diabetes, hypertension persist despite successful acromegaly treatment

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April 9, 2018

Moises Mercado
Moises Mercado

Diabetes and hypertension are common among Mexico residents with acromegaly despite successful medical or surgical treatment of the disease, according to findings from a retrospective study.

“Comorbidities such as diabetes and hypertension persist in a substantial number of patients despite successful treatment of acromegaly,” Moises Mercado, MD, FRCP, a surgeon and specialist in internal medicine and endocrinology at the Neurology Center Research Unit at National Medical Center in Mexico City, told Endocrine Today. “This implies that chronic growth hormone excess may lead to irreversible changes in glucose metabolism and blood pressure control.”

Mercado and colleagues analyzed data from 522 adults enrolled in the Acromegaly Clinic of Hospital de Especialidades in Mexico City between 2000 and 2015 who were treated according to pre-established protocol (mean age, 44 years; 64% women). Prevalences of diabetes and hypertension in the cohort were compared against figures from the 2016 National Health and Nutrition Survey in Mexico. Within the cohort, 23.6% were in remission, 17.8% had controlled disease, 28.6% had active disease, 12.4% had insulin-like growth factor I discordance and 18.6% had GH discordance. Researchers used Cox proportional hazard models to assess the relationship between the prevalence of diabetes and hypertension and biochemical indices of acromegalic control.

Upon diagnosis, 30% of the cohort had diabetes, and 37% had hypertension. During a mean follow-up time of 7.4 years, the prevalence of both comorbidities did not change (30.6% for diabetes and 38% for hypertension at last visit) and was markedly higher among participants vs. the overall Mexican adult population (9.4% and 25.4%, respectively, for diabetes and hypertension).

After stratifying for disease activity status, diabetes was more prevalent at the last follow-up visit in patients with biochemically active disease (40%) and those with IGF-I discordance (37%) vs. patients who achieved surgical remission (25%; P = .001).

Additionally, diabetes was associated with an IGF-I level at diagnosis that was more than two times the upper limit of normal, according to researchers, as well as with the persistence of active acromegaly, presence of hypertension at last visit, presence of a macroadenoma and female sex.

“The good news is that such persistence of diabetes and hypertension does not result in an increased mortality rate, provided patients are properly controlled with antidiabetic and antihypertensive medications and close surveillance,” Mercado said.

The findings follow a similar retrospective study conducted by French researchers in 2017, also noting that patients with acromegaly controlled through medication or in remission continue to have a higher prevalence of diabetes than the overall population. As Endocrine Today previously reported, Claire Rochette, MD, of Aix-Marseille University in Marseille, France, and colleagues found that patients with controlled acromegaly had a higher prevalence of diabetes (21.6% vs. 6.9%) when compared with the French epidemiologic data; however, the prevalence of other metabolic conditions was either similar to or lower than that of the French population. The acromegaly cohort had a lower prevalence of hypertension (39% vs. 49.9%), a similar prevalence of elevated LDL cholesterol (34.3% vs. 31%) and a lower prevalence of hypertriglyceridemia (13.3% vs. 22.3%) when compared with the general population. – by Regina Schaffer

For more information:

Moises Mercado, MD, FRCP, can be reached at National Medical Center, Sur 132, #142, Suite 210, Colonia las Americas, Mexico City, 01120; email: moises.mercado@endocrinologia.org.mx.

Disclosures: The authors report no relevant financial disclosures.