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Increased diabetes prevalence persists in acromegaly, even after remission

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December 1, 2017

Patients with acromegaly that is controlled through medication or in remission continue to have a higher prevalence of diabetes than the general population, according to a retrospective study by researchers in France.

“The comorbidities associated with acromegaly are known to lead to an impaired quality of life and an average 10-year reduction in life expectancy in untreated patients compared with the general population, mainly due to cardiovascular disease,” Claire Rochette, MD, of Aix-Marseille University in Marseille, France, and colleagues wrote in the study background. “A still-debated question is the persistence of such comorbidities on a long-term basis once the control of hypersecretion is obtained.”

Rochette and colleagues analyzed data from 130 patients with acromegaly either in remission or controlled through medication, surgery or radiation and followed in a single French center for 15 years (75 women). Patients were included in the study the first time they had both suppressed growth hormone after an oral glucose tolerance test (< 1.2 mUI/L) or a mean of GH values less than 1 ng/mL in patients with diabetes and a normal insulin-like growth factor I value for their age and sex, and if they had at least one evaluation of the complications before or after hypersecretion control. During follow-up, researchers evaluated both metabolic (diabetes, hypertension, LDL cholesterol and triglyceride levels) and CV complications, comparing them with publicly available epidemiologic data from the French Nutrition and Health Survey and the Mona Lisa study.

The cohort was followed for a mean of 72 months after remission.

When compared with the French epidemiologic data, patients with controlled acromegaly had a higher prevalence of diabetes (21.6% vs. 6.9%); however, the prevalence of other metabolic conditions was either similar to or lower than that of the general 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.

The researchers noted that, after excluding patients controlled by radiation techniques, 41.2% of patients controlled by somatostatin analogues had blood glucose disorders vs. 20.5% of those cured through surgery (P = .23).

“As the risk of recurrence can be considered very low, the major remaining issue is the extent to which complications might reverse,” the researchers wrote. “Our study clearly shows that despite a prolonged follow-up after remission, some of these complications will persist, emphasizing the need for a specific and regular follow-up of patients at high cardiovascular risk profile. The final prevalence of comorbidities does not seem higher than in the general population, except for glucose disorders, the main parameter that should be closely followed on a long-term basis after remission.”

The researchers called the findings a “highly relevant issue,” as approximately one-quarter of the patients were lost to follow-up after control of hypersecretion. – by Regina Schaffer

Disclosures: The authors report no relevant financial disclosures.